Can a growing team get strong coverage without breaking the payroll? Many employers ask this while weighing plan tiers, provider networks, and predictable costs.
UnitedHealthcare and Anthem offer digital stores and extensive provider networks that help employers compare plans and buy group coverage online. UnitedHealthcare serves millions of covered employees and lists thousands of physicians and hospitals, while Anthem connects to the Blue Cross Blue Shield network for broad access.
This guide explains where to research options — from carrier portals and state exchanges to the federal pathway — and highlights how licensed agents can speed enrollment. Call UnitedHealthcare at 1-866-469-9226 (all states except NY) or 1-888-201-4216 (NY) for direct support.
Use the linked group health insurance guide for plan basics and the cost and plan overview to compare estimates and prepare to request quote.
Key Takeaways
- Small business health insurance today: eligibility, ACA rules, and SHOP basics
- Shop health insurance small business: how to compare, choose, and enroll
- Group health plan options for small businesses
- Coverage and benefits that support your employees’ whole health
- Costs, contributions, and small business savings opportunities
- Provider networks, access to care, and digital tools
- State-by-state considerations, including New York
- How agents and brokers help small business employers choose coverage
- Conclusion
- FAQ
- Compare carrier digital stores and state exchanges to find the best fit for employees.
- Look for large provider networks and 24/7 virtual care to boost access and satisfaction.
- Licensed agents can streamline quotes, enrollment, and ongoing support.
- Plan tiers and employer contribution levels drive monthly costs and predictability.
- Use phone or chat with carriers to finalize choices before open enrollment closes.
Small business health insurance today: eligibility, ACA rules, and SHOP basics
Understanding who qualifies under federal rules makes enrollment simpler for employers and teams.
The Affordable Care Act sets the baseline for group plans. In most states, employers with 50 or fewer full-time equivalent employees (FTEs) can use the SHOP marketplace. In California, Colorado, New York, and Vermont that limit rises to 100 FTEs.
If your company has fewer than 50 FTEs, you aren’t required to offer coverage. Many businesses still provide plans to attract and keep talent.
Who qualifies under the Affordable Care Act
The ACA defines full-time employees and minimum standards. SHOP plans must cover Essential Health Benefits and meet minimum value (plan pays at least 60% of allowed costs). Plans appear in Bronze, Silver, Gold, and Platinum tiers.
Understanding the Small Business Health Options Program (SHOP) Marketplace
Employers choose coverage options for their teams; employees then pick from those employer-offered plans. Employees enrolling through the SHOP do not get federal individual subsidies, so employer contributions matter.
- Eligibility: most states ≤50 FTEs; CA, CO, NY, VT ≤100 FTEs.
- Plan standards: Essential Health Benefits and minimum value rules apply.
- Enrollment paths: licensed agent, carrier portal, state exchange, or healthcare.gov/small-businesses.
| Feature | Who it affects | Why it matters | Action |
|---|---|---|---|
| FTE limit | Employers by state | Determines eligibility for SHOP | Calculate FTEs including part-time/seasonal hours |
| Minimum value | All group plans | Ensures comprehensive coverage (≥60% paid) | Compare metal tiers to match budget |
| Premium contributions | Employers & employees | Impacts net cost to staff without subsidies | Set employer contribution strategy |
| Enrollment routes | Employers | Multiple ways to enroll and compare | Use a broker or carrier portal for guidance |
Shop health insurance small business: how to compare, choose, and enroll
Begin with a clear headcount and benefits goals so you can narrow which plan types fit your workforce. Confirm full-time equivalents (FTEs) to see whether you use the SHOP marketplace or a state exchange pathway.
Compare metal tiers at a glance: Bronze plans usually lower premiums but raise out-of-pocket costs. Silver, Gold, and Platinum shift more costs to premiums and reduce expenses at the point of care. Look at copays, deductibles, prescription coverage, and network size when you compare plans.
Enroll through your state exchange (examples: DC Health Link, Maryland Health Connection, Massachusetts Health Connector, NY State of Health), healthcare.gov/small-businesses, carrier portals, or via a licensed agent. Agents provide live chat, scheduled help, and can complete enrollment for you.
- Confirm headcount and FTE status to set contribution strategy.
- Request a quote from carriers or an agent to model premiums and employee costs.
- Use digital tools that let employees shop within the employer’s selections and see real cost impact.
Document why you choose coverage options and create a simple rollout for employees. That reduces questions, boosts participation, and makes renewals easier for your company and your staff.
Group health plan options for small businesses
Choosing the right group option starts with balancing predictable costs and member access.
Fully insured plans
Fully insured plans charge a fixed monthly premium. The insurance company manages claims and assumes financial risk. That reduces admin burden and helps budgeting for your business.
Level funded plans
Level funded plans blend self-funding with predictability. Employers pay a set amount each month based on expected claims.
If claims are lower than expected, the plan can return a year‑end surplus. That makes this option attractive for teams that want more cost visibility and possible savings.
Surest plans
Surest plans focus on simplicity. They use clear, upfront copays with no deductibles or coinsurance.
This model helps employees understand costs and reduces surprise medical bills.
Network and plan types
Choose between HMO, PPO, POS, and high-deductible plans based on how staff access care.
HMOs suit location-based teams who want coordinated primary care. PPOs help traveling employees who need broader out-of-network access.
Carriers such as Anthem and UnitedHealthcare offer broad networks and integrated pharmacy tools that support care coordination and digital member services.
| Option | How it works | Best for |
|---|---|---|
| Fully insured | Fixed premium; carrier handles claims and risk | Employers wanting predictable monthly costs and low admin |
| Level funded | Estimated monthly payments; potential year-end surplus | Employers seeking flexibility and possible savings with reporting |
| Surest | Upfront copays; no deductibles or coinsurance | Workforces that prefer price certainty and simple claims |
| HMO / PPO / POS / HDHP | Different network rules and cost-sharing structures | Match to travel patterns, local access, and premium vs. out-of-pocket tradeoffs |
- Compare pharmacy integration and digital tools when selecting plans.
- Map plan features to retention goals and renewal strategies.
Coverage and benefits that support your employees’ whole health
A modern benefits package ties medical coverage to wellness, virtual care, and programs that remove cost barriers.
Essential Health Benefits and minimum value requirements
Ensure your plan meets Essential Health Benefits (EHB) and the minimum value standard (≥60%). That guarantees coverage across preventive care, prescriptions, maternity, and mental health so employees get comprehensive care when they need it.
Whole-person programs: wellness, behavioral support, and care management
Many carriers add wellness incentives, behavioral health resources, and care management to improve outcomes and productivity.
Programs like 24/7 virtual visits give employees quick access to care outside office hours.
“Rewards and medication programs can remove out-of-pocket costs for critical drugs, boosting adherence.”
Ancillary options: dental, vision, life, and disability
Offer ancillary lines—dental, vision, life, and disability—to round out your benefits and support retention.
Bundling medical and ancillary plans can simplify admin and sometimes lower total costs. For integrated examples, see bundled benefits and packages such as benefits packages for small businesses.
- Make sure plans meet EHB and minimum value so employees receive broad coverage.
- Use whole-person programs and rewards to remove cost barriers to treatment.
- Include ancillary options employees value and communicate how to use them.
Costs, contributions, and small business savings opportunities
Keeping coverage affordable starts with clear cost drivers and a contribution plan.
What drives premiums:
What drives premiums: plan type, network, state, and employee ages
Premiums vary by plan type, network breadth, required benefits, state rules, and the ages of employees. Richer benefits and broader networks raise costs. Location and local claims trends also change pricing.
Employer contributions and sharing costs with employees
Most employers pay 50%–100% of premiums and sometimes contribute to dependent coverage. Decide a contribution strategy that balances affordability for employees with predictable costs for the company.
Small Business Health Care Tax Credit: eligibility and potential savings up to 50%
If you have fewer than 25 FTEs (excluding owners/family), average wages under $62,000 in 2023, and you pay at least 50% of premiums, you may qualify for a tax credit up to 50%.
Tax deductibility of premiums for businesses
Premiums paid by the business are generally tax deductible as a business expense. Consult a tax advisor for specifics that apply to your situation.
- Understand primary cost drivers and model their impact on monthly costs.
- Use plan design levers—copays, deductibles, Rx tiers—to tune premiums without losing essential coverage.
- Request a quote from carriers or an agent to get precise pricing for your census and forecast budgets.
| Cost driver | How it affects premiums | Employer action | Expected outcome |
|---|---|---|---|
| Plan richness | Higher premiums for broader benefits | Adjust copays/deductibles | Lower monthly costs, stable coverage |
| Network size | Wider networks increase rates | Choose in-network focused plans | Reduced premiums, possible access tradeoffs |
| Demographics & location | Older or higher-cost regions raise prices | Consider level funded or regional plan mixes | More predictability; potential surplus returns |
| Tax credits & deductions | Can cut net employer cost | Confirm eligibility and file appropriately | Lower after-tax expense; improved affordability |
“Model total costs—including employer shares and expected out-of-pocket expenses—before you finalize plan choices.”
Provider networks, access to care, and digital tools
Strong provider networks and digital tools determine how fast employees get care and how easy benefits feel.
Nationwide access to physicians, hospitals, and local providers
Large national networks help employees find in‑network physicians and hospitals near home or on the road. UnitedHealthcare lists 1.8M+ clinicians and 5,600+ hospitals, while Anthem links to the BCBS network for broad access.
Verify local primary care and specialists your team prefers. If your workforce spans states, choose plan options that cover multi‑state care and continuity.
24/7 virtual visits and member apps that simplify care
Virtual visits cut time away from work and speed treatment for common issues and follow‑ups. Both carriers offer round‑the‑clock telemedicine and mobile apps.
Member apps centralize ID cards, cost estimators, provider search, and appointment scheduling. Administrative portals also simplify enrollment, eligibility checks, and ID card requests.
- Compare network breadth, referral rules, and out‑of‑network features to match business health priorities.
- Use analytics and reporting to track top providers and tune plan choices at renewal.
- Train employees to use virtual care for appropriate needs to lower costs and boost access.
| Feature | UnitedHealthcare | Anthem | Why it matters |
|---|---|---|---|
| Network size | 1.8M+ physicians; 5,600+ hospitals | Broad BCBS access nationwide | Better in‑network access while traveling |
| Virtual care | 24/7 Virtual Visits; member rewards | 24/7 online visits; Sydney Health app | Faster care and fewer missed work hours |
| Admin tools | Digital portals and reporting | EmployerAccess for admins and mobile app | Saves HR time; streamlines enrollment |
| Cost programs | Medication programs reduce out‑of‑pocket costs | Integrated pharmacy and digital support | Improves adherence and lowers total cost |
For help comparing options and enrolling, see our guide to the best health insurance for small business.
State-by-state considerations, including New York
When your team spans state lines, eligibility limits and regional plan choices will change how you offer benefits.
Employee thresholds: most states set SHOP eligibility at 50 or fewer FTEs. California, Colorado, New York, and Vermont raise that cap to 100 FTEs. Confirm your FTE count before you pick a path.
Where to shop and compare plans
Use your state exchange for localized pricing and plan details. Examples include DC Health Link, Maryland Health Connection, Massachusetts Health Connector, and NY State of Health. You can also browse carrier digital stores or visit our state-by-state guide for specifics.
Contact paths and NY specifics
Call UnitedHealthcare at 1-866-469-9226 for help in all states except New York. For New York employers, use 1-888-201-4216 to reach teams familiar with local rules and plan options.
- Coordinate offerings when employees live in multiple states to keep consistent coverage.
- Encourage employees shop within employer-selected choices so cost-sharing compares fairly.
- Track renewal dates that may vary by state and carrier to avoid gaps.
“Confirm state rules early—regional network differences affect access and rating.”
| Issue | Action | Why it matters |
|---|---|---|
| FTE threshold | Calculate headcount | Determines exchange eligibility |
| Regional networks | Check local providers | Affects specialist access |
| Contact path | Use correct phone line | Saves enrollment time |
How agents and brokers help small business employers choose coverage
Licensed agents bring census-aware comparisons and real-time quotes so leaders can pick plans with confidence.
When to work with a licensed agent vs. shop on your own
Use a licensed agent when you want side-by-side comparisons of carriers, plan tiers, networks, and employer contribution strategies tailored to your census and locations.
If you prefer to research independently, review offerings on SHOP, state exchanges, or carrier sites. Then bring an agent in to validate pricing and confirm underwriting requirements.
- Agents streamline quote requests, organize underwriting documents, and manage enrollment tasks.
- Experienced brokers explain deductibles, coinsurance, and Rx formularies in plain terms so employers choose coverage with confidence.
- For multi-state setups, agents coordinate availability and compliance to keep benefits consistent.
“Bring an agent in early if you’re changing carriers or adding group health insurance and ancillary lines.”
| Service | What agents do | Employer benefit |
|---|---|---|
| Quotes & comparisons | Live chat, scheduled appointments, carrier tools | Faster, tailored pricing |
| Enrollment support | Eligibility checks, document filing, ID card setup | Fewer errors and faster onboarding |
| Ongoing service | Renewal strategy, eligibility updates | Sustained plan performance and fewer surprises |
Conclusion
Conclusion
A clear checklist—eligibility, plan tiers, networks, and contribution levels—makes final decisions faster and fairer.
Under the Affordable Care Act, the SHOP marketplace gives employers a practical path to group coverage that meets Essential Health Benefits and minimum value standards.
Mix plan types—fully insured, level funded, or straightforward copay options—and bundle medical with dental, vision, and life insurance to help control costs and boost retention.
Work with a licensed agent to compare plan options, confirm potential tax credit eligibility, and request a quote that fits your census and locations.
Next steps: call 1-866-469-9226 (states except New York) or 1-888-201-4216 (New York), or visit your state exchange to start enrollment and ensure employees can shop and enroll on schedule.
FAQ
Who qualifies under the Affordable Care Act for employer group plans?
Employers with one or more employees can offer group plans, but eligibility for certain tax credits and SHOP programs depends on headcount, average employee wages, and whether you offer coverage to full-time staff. Businesses with 50 or fewer full-time-equivalent employees typically qualify for smaller-group rules and potential Small Business Health Care Tax Credits when meeting wage and contribution criteria.
What is the Small Business Health Options Program (SHOP) Marketplace?
The SHOP Marketplace is a federal or state program that helps employers compare and offer group coverage to staff. It simplifies enrollment, lets employers choose contribution levels, and can connect you with certified agents. Some states run their own exchanges while others use the federal portal.
How do I determine whether to offer coverage for fewer full-time employees or for a growing team?
Start by counting full-time equivalents (FTEs) and assessing employee needs like family dependents and benefit preferences. If your workforce is small and variable, consider plans with flexible contribution rules. Growing teams may benefit from designs that scale, such as level-funded options or broader network plans.
How should I compare plan tiers like Bronze, Silver, Gold, and Platinum?
Compare premium costs, out-of-pocket limits, deductible amounts, and covered services. Bronze plans usually have lower premiums and higher cost-sharing; Platinum plans have higher premiums but lower out-of-pocket costs. Choose based on how much employees use care and how predictable you want employer expenses to be.
What are the enrollment channels for group plans?
Employers can enroll through federal or state marketplaces, a carrier’s small-group portal, or via a licensed agent or broker. Online enrollment often integrates payroll and eligibility, while agents provide tailored guidance and access to multiple carriers.
How can I request a quote and get state-specific recommendations?
Provide your business location, FTE count, and basic demographic data to carriers or a licensed agent. They’ll generate quotes based on plan availability in your state and recommend designs that reflect local costs and provider networks.
What is the difference between fully insured and level-funded plans?
Fully insured plans transfer risk to the carrier for predictable monthly premiums and claims handling. Level-funded plans combine a fixed monthly payment with the potential for refunds if claims are lower than expected, offering more transparency and possible savings for healthier groups.
What are “Surest” plans and how do they differ from traditional designs?
Surest-style plans emphasize fixed copays with little or no deductibles and minimal coinsurance, making member costs predictable. They suit employers who want straightforward budgeting and high cost transparency for routine care.
How do HMO, PPO, POS, and high-deductible designs affect access and cost?
HMOs limit care to network providers and require referrals, lowering premiums. PPOs offer wider networks and out-of-network options at higher cost. POS blends features of HMO and PPO. High-deductible plans pair with health savings accounts for tax-advantaged savings but shift more upfront cost to members.
What essential benefits must group plans cover?
Plans must cover a set of essential benefits defined by federal rules, including ambulatory care, prescription drugs, mental health, maternity, and preventive services. Employers should also confirm minimum value requirements to meet regulatory standards.
What whole-person programs should employers consider for employee well-being?
Consider wellness programs, behavioral health services, chronic condition management, care navigation, and telehealth. These programs improve outcomes, reduce absenteeism, and can lower long-term costs when integrated with core medical coverage.
What ancillary options can I add beyond medical coverage?
Common add-ons include dental, vision, life insurance, short- and long-term disability, and voluntary benefits. These help attract and retain talent by filling gaps not covered by core plans.
What drives premium costs for group plans?
Premiums depend on plan type, network breadth, state regulations, employee age and health profile, and overall utilization. Geography and local provider pricing also play major roles.
How much should employers contribute toward employee premiums?
Contribution strategies vary; many employers cover a portion of employee-only premiums and set a percentage for dependents. Balance affordability for staff with budget predictability. Contributions can affect tax treatment and eligibility for certain credits.
Who is eligible for the Small Business Health Care Tax Credit and how much can it save?
Small employers with up to 25 full-time-equivalent employees, average wages below a state-set threshold, and who pay at least 50% of employee-only premiums may qualify. The credit can offset a significant portion of employer costs, up to 50% for tax-exempt employers and 35% for others, depending on circumstances.
Are employer-paid premiums tax-deductible?
Yes. Employer contributions for group coverage are generally tax-deductible as a business expense, and employee premiums paid through pre-tax payroll deductions also reduce taxable income for staff.
How broad are provider networks and what about virtual visit options?
Many carriers offer nationwide networks with local provider access and 24/7 virtual visits via apps or telehealth platforms. Check network directories for in-network physicians and confirm telemedicine availability and copays before selecting a plan.
What state-specific issues should I consider, especially for New York?
State rules vary on rating, required benefits, and employee thresholds. New York, California, Colorado, and Vermont have unique mandates and support channels. Verify local regulations, exchange platforms, and any state-run assistance specific to your location.
Where can employers find marketplace options and carrier storefronts?
Employers can use federal resources such as healthcare.gov/small-businesses, visit state exchanges, or contact carrier websites and local agent offices. Availability differs by state, so compare both marketplace and direct-carrier offerings.
How do contact paths differ for all states except New York versus New York-specific support?
Most states use the federal portal or their own exchanges and carrier networks. New York provides distinct support channels, including state-specific navigator programs and carrier assistance; employers should follow their state’s guidance to connect with the correct enrollment resources.
When should I work with a licensed agent or broker?
Use an agent when you need customized plan design, multi-carrier comparisons, help with compliance, or hands-on enrollment support. For simple offerings and direct carrier pricing, an employer may enroll independently, but agents often save time and ensure you meet regulatory requirements.