Toggle navigation
health insurance for small business owners
Small Business

Health insurance for small business owners

When it comes to health insurance for small business owners, there are now more options than ever! With health reimbursement arrangements, or HRAs, you can offer your employees flexible, customizable, tax-free reimbursements for health insurance. And in many cases, HRAs offer medical insurance for small business owners as well. Let’s take a look at the options available for health insurance for small business owners.

Ready to learn how much you can reduce benefits cost?

What are the options for health insurance for small business owners?

Here are the options for medical insurance for small business owners. 

  1. Group insurance: Historically, small-group insurance has been the primary option for many small employers who are looking to offer health benefits for their employees. In fact, around half of the U.S. population is covered through their employer plans, according to Kaiser Family Foundation.  These plans are well known, tax-free, with solid product options, and are proven to be an effective retention strategy.  But they aren't the only option.

    We see that as a good thing, as they are expensive, one-size-fits-all, and erratic: premiums can go up every year. What's more, as an owner you have to worry about participation rates. And remember, since your employees will all be in the same risk pool, one sick employee means higher prices. The traditional small group plan separates patients from the process; they simply swipe their card and aren't empowered to make wise financial decisions. We'll go out on a limb and say that this attitude doesn't help an already expensive healthcare system.

  2. Self-funded plans: Technically speaking, self-insured employers pay for claims out of pocket when they arise as opposed to paying a predetermined premium to a carrier for a small group plan. This type of plan is usually seen with a large enterprise as a means to control their healthcare spend and manage their own risk pool. A third party administrator (TPA) is engaged to process claims for this type of plan. The benefits of this type of plan are that it's more customizable to your workforce, you have control over the health plan reserves so you can maximize your interest income, there's no pre-funding of health coverage, and you aren't subject to state health insurance premium taxes (typically 2-3%).

  3. Health Reimbursement Arrangements(HRA): A health reimbursement arrangement is an affordable, tax-advantaged alternative to traditional insurance. The reimbursement model is simple: An employer decides how much money to contribute each month, provides their employees with standard information about how the HRA works, and outsources some administrative functions like verifying coverage. The employee chooses a plan that works for them, submits receipts for premium payments and medical expenses (if applicable), and gets reimbursed. Super simple.

What is the best medical insurance for small business owners? 

For more reasons than one, we believe HRAs are the best option for health insurance small business owners. 

ICHRA: the individual coverage HRA is based on reimbursing employees for insurance rather than buying it for them, and brings with it a design feature that allows owners to scale benefits by class.

  • It offers the most flexibility, with 11 ICHRA employee classes, the employer gets to choose, for example, how much to reimburse full time vs. part time employees, seasonal employees, and salaried vs. non-salaried employees.
  • ICHRA works for companies of any size: from a start-up to a large company.
  • There are no reimbursement limits.
  • It can also be combined with a group plan.

QSEHRA: the qualified small employer HRA (sometimes called a small business HRA) allows small employers to set aside a fixed amount of money each month that employees can use to purchase individual health insurance or use on medical expenses, tax-free.

  • It works for businesses with fewer than 50 employees.
  • There are QSEHRA contribution limits (for 2022: For an individual: $5,450/year. For a family: $11,050/year).
  • It cannot be combined with a group plan.
  • Unlike ICHRA, QSEHRA reimbursements must be the same for everyone, but you can vary by age and family size.

If you want to dive deeper into ICHRA and QSEHRA, we have comprehensive guides (here and here), and FAQ pages (here and here).

How does HRA eligibility work for small business owners?  

Whether or not self-employed owners can participate in an HRA depends on how the plan and business are set up.

In order for a business owner to participate in an HRA, they must be considered an employee of the business.

Partnerships: Partners are directly taxed, making them self-employed and not eligible for participation in either ICHRA or QSEHRA. The QSEHRA Loophole: if the partner’s spouse is a W-2 employee (and not a partner spouse) then the owner can participate in the QSEHRA as a dependent of the spouse.  

Corporations:  (Including C-Corps, B-Corps, Non-Profits, and LLCs taxed as C-Corps - anything where the entity is separate from ownership.) Corporations are the easiest entity type to handle when it comes to health insurance because owners are considered employees and can benefit from the company’s QSEHRA or ICHRA. Their dependents and any W2 employees can benefit as well.

S-Corps: An S-Corp owner that owns more than 2% of the company is considered self-employed and not an employee, therefore typically cannot participate in the HRA. However, self-employed individuals can already deduct some health insurance expenses without an HRA.

Sole proprietors: These unincorporated businesses are owned and operated by one individual with no distinction between the business and owner. In a nutshell: The sole proprietor is not an employee and will not qualify for an HRA.

Take Command can help with medical insurance for small business owners!

While we always advise our clients to speak with their CPA before jumping in, we are ready to chat on our website if you have any specific questions about your business and how HRAs could help. Setting up a QSEHRA or an ICHRA is simple and quick, and our team is here to help if you need it.

And remember, what's best for one company isn't necessarily best for another. It is important to consider your company's unique makeup and your location market conditions to determine what the best plan will be for your company benefits.

Helpful resources →

Ask our experts how to get started today (it's easy!)

Small Business

Let's talk through your HRA questions

Fill out the form below to connect with our team and see if an HRA is a good fit.