Should I offer a stipend in lieu of health insurance?

by Keely S.

For employers, it makes sense to evaluate all your options when it comes to pricey benefits and employee coverage. How do HRAs stack up against some of the more traditional options of offering health benefits like group plans, health stipends or pay increases? It's a fair question. The key difference rests in the tax savings that accompany an HRA.

Let's jump in to your options and see what works best for you. 

Should I offer a stipend in lieu of health insurance?

Some employers offer a regular, fixed amount of money, or stipend, to their employees to help cover the cost of health insurance. While this option is easy from a time and administration perspective, the value of these dollars will be greatly diminished because they are considered taxable income (~30%). Furthermore, simply writing off the stipend as a business expense will have payroll as well as income tax implications.

Health stipends aren’t subject to compliance issues that group plans have, and they can be really easy to administrate through payroll. But they aren’t tax advantaged like an HRA. Not only are small businesses required to pay payroll tax on the reimbursements, employees must claim the stipend as income and there isn’t exactly any accountability for whether or not the money is even used for health insurance.

Looking for a real world example?

Let’s say a small business owner, Steph, runs a 10 person company offering $300 a month in salary increases, totalling $3,000 per month for her team for a health stipend, which is subject to several types of taxes. In a one month period, a 25% employee income tax will run around $750, a 15% employer payroll tax runs about $450, totaling $1,150 in taxes.

Small business owner Jeff offers reimbursement through an HRA and avoids employee income tax and employer payroll tax, saving a whopping total of $1,150 per month more than Steph (roughly a 30% savings). With an HRA, employees get to use the full value for their health insurance and medical expenses. What's more, in contrast to a health stipend that really comes with no accountability, an HRA allows small businesses to keep the unused funds at the end of the year and it's only paid out when employees submit a claim for reimbursement.

Reimburse employees with a health reimbursement arrangement

For companies that help employees with health insurance by offering a “health stipend” or by “adding to employee salaries”, HRAs will typically have a huge tax advantage.

Sometimes referred to as “401(K)-style” insurance, two recently created HRAs allow an employer to reimburse for medical expenses and/or insurance premiums on a tax-free basis. Under this arrangement, employees purchase their own health insurance on the open market and then submit claims to their employer to get reimbursed for the cost of their premium and if allowed, all qualified medical expenses.

  • The qualified small employer HRA (QSEHRA) requires your business to be small, with less than 50 Full Time Equivalent employees, and you can't offer a group plan at the same time. If you meet those qualifications, you can use an HRA administration tool (like ours!) to create your QSEHRA, decide how much you’ll reimburse each month (up to the contribution limits), let your employees choose the plan that works best for them, and reimburse them when they submit receipts!
  • The individual coverage HRA (ICHRA) is almost like a “super-charged” version of the QSEHRA. Instead of being capped at 50 employees, employers of any size can set up an ICHRA for their teams. There are also no contribution limits with this HRA. Another key differentiator from HRAs in the past? ICHRA allows business owners to customize their reimbursements across different classes of employees. While everyone must be treated fairly within a certain class, reimbursement rates can vary between full time, part time, seasonal, remote, etc.

Ready to learn more about HRAs?

Calculate your HRA tax savings and see just how much you can save. Learn more about the reimbursement rules for QSEHRA. Or settle in for some comprehensive reading about the ICHRA.

We are always available to chat online - please reach out! Or, we have lots of resources to help guide you, and we've written a slew of blog posts all about HRAs. Here's a step by step guide to how HRAs work. We also have a comprehensive guide to small business HRAs.


Picture of Keely S.

Hi, I'm Keely S.! A wife to one and mother to four, Keely does all of the things. She’s also dabbled in personal finance blogging and social media management, contributed to MetroFamily magazine, and is passionate about good food, treasure hunting and upcycling. With a B.S. in Psychology from the University of Oklahoma and a knack for a witty punchline, it’s no surprise that Keely’s social posts are as clever as they get. In her (very little) free time, you’ll find Keely with her nose in a book or trying out a local restaurant with her family.