health insurance for small business owners in pa

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Pennsylvania Small Business Health Insurance Information

The purpose of this guide is to provide a general overview of pennsylvania small business health insurance. the guide reviews small business health insurance options for pennsylvania small businesses..

Building a successful business is hard work. Finding affordable small business health insurance doesn’t have to be. All small businesses face special challenges when it comes to finding and getting health insurance coverage. Luckily, recent health care reform legislation provides small businesses with special opportunities to secure affordable health insurance.

Pennsylvania Core Small Business Health Insurance Options

When evaluating your small business health insurance options in Pennsylvania, you should immediately compare the costs and benefits of the following three options:

Offering Traditional Small Business Health Insurance Coverage,

Offering a Defined Contribution Health Plan that Reimburses Employees for Individual Health Insurance Coverage, and

Offering Nothing

Pennsylvania Small Business Health Insurance Overview

There are two primary categories of health insurance for small businesses to choose from:

Individual health insurance, 

Group health insurance. 

1) Individual Health Insurance

Individual health insurance plans are health insurance plans purchased by individuals to cover themselves or their families. Anyone can apply for individual health insurance. Small business owners who can’t offer group coverage due minimum contribution (or minimum participation) requirements typically purchase individual and family plans for themselves and their families. In 2014, insurance companies will no longer be able to decline individuals for individual health insurance based on a pre-existing medical condition. Also, starting in 2014, there are new special tax incentives available to businesses and employees when employees purchase individual health insurance. In some cases, self-employed persons who purchase their own health insurance may be able to deduct the cost of their monthly premiums. When small businesses decide on the individual health insurance route, they often create a "Pure" Defined Contribution Health Plan to  reimburse employees tax-free for individual premiums .

2) Group Health Insurance

Group health insurance plans are a form of employer-sponsored health coverage. Costs are typically shared between the employer and the employee, and coverage may also be extended to dependents. In certain states, self-employed persons without other employees may qualify for group health insurance plans.

Four Types of Pennsylvania Small Business Health Insurance Plans

Whether you’re looking at individual health insurance or group health insurance, there are several different types of health plans available. The four you should absolutely know are:

PPO Health Insurance Plans,

HMO Health Insurance Plans,

HSA-Qualified Health Insurance Plans, and

Indemnity Health Insurance Plans.

The plan type that is best for you and your employees depends on what you and your employees want, and how much you are willing to spend. Here’s a brief review of the four popular types of health insurance plans:

1) PPO Health Insurance Plans

PPO or “Preferred Provider Organization” plans are the most common. Employees covered under a PPO plan need to get their medical care from doctors or hospitals on the insurance company’s list of preferred providers in order for claims to be paid at the highest level.

2) HMO Health Insurance Plans

HMO stands for “Health Maintenance Organization.” HMO plans offer a wide range of health care services through a network of providers that contract exclusively with the HMO, or who agree to provide services to members. Employees participating in HMO plans will typically need to select a primary care physician (“PCP”) to provide most of their health care and refer them on to HMO specialists as needed.

3) HSA-Qualified Health Insurance Plans

HSA-qualified plans are typically PPO plans designed specifically for use with  Health Savings Accounts  (HSAs). An HSA is a special bank account that allows participants to save money – pre-tax – to be used specifically for medical expenses in the future. Section 105 Healthcare Reimbursement Plans (HRPs) are often used in place of HSAs due to their advantages for employers.

4) Indemnity Health Insurance Plans

Indemnity plans allow members to direct their own health care and generally visit any doctor or hospital. The insurance company then pays a set portion of the total charges. Employees may be required to pay for some services up front and then apply to the insurance company for reimbursement. 

Pennsylvania Small Business Resources*

Pennsylvania Health Insurance Coverage:

Group Plans: There is a maximum 6-month look-back/12-month exclusionary period for pre-existing conditions on enrollees that do not have prior coverage. Benefits will vary depending on the chosen plan.  Pre-existing health conditions covered.  

Individual Plans: Assorted plans depending on medical needs. There is a maximum look-back period of 60 months and a maximum exclusion period of 24 months for pre-existing conditions on enrollees that do not have prior coverage. Elimination riders are permitted . Limits on pre-existing health conditions may apply.  

COBRA: Coverage available for 18-36 months depending on qualifying events. Benefits are what you had with your previous employer.  Pre-existing health conditions covered.

HIPAA: Benefits are based on program selected. There is no expiration of coverage.  Pre-existing health conditions covered.

HIPAA: Premium assistance that pays employer-sponsored health insurance or Cobra premium available.  Pre existing health conditions covered.

 Pennsylvania Health Insurance Eligibility:

Group Plans: Guaranteed coverage for companies with 2-50 employees. Eligible employees must work at least 30 hours a week. Owner can count as an employee. Owner name on business license must draw wages from the company.  

Individual Plans: Eligibility is subject to medical underwriting. If you are denied coverage for a medical condition, you may be eligible for AHIP, or PCIP.  

COBRA: Guaranteed coverage available for employees who work for businesses with 20 or more employees. Employees have 60 days from date of termination to sign-up.  

HIPAA: Must have had 18 months of continuous coverage and completely exhausted Cobra or state continuation coverage. Must not have lost coverage due to fraud or non-payment of premiums. You have 63 days to enroll.  

HIPAA: Must qualify for Medicaid and have access to Employer-Sponsored Insurance or Cobra.

Pennsylvania Health Insurance Monthly Cost:

Group Plans: Costs depend on employer contribution and the  +  20% of the Insurance company’s Index rate.  

Individual Plans: Costs for Individual coverage vary. There are no rate caps.  

COBRA: Costs vary between 102% to 150% of group health rates.  

HIPAA: Premiums will depend on plan chosen.  

HIPAA: Reimburses the full employer-sponsored insurance premium amount by check monthly. Pays the insurance company directly for people on COBRA or eligible small businesses.  

*Source: www.coverageforall.org

Pennsylvania : Average “Single” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*

Pennsylvania : Average “Family” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*

Pennsylvania : Average “Employee-Plus-One” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*

Pennsylvania : Average Per Person Monthly Premiums in the Individual Market, 2010*

*Source: statehealthfacts.org

Small Business Health Insurance Reform

Are you ready for health care reform ("ACA") in 2014?

Today, employers are more stressed than ever. Here’s why:

The business environment is uncertain,

Employer-sponsored health insurance costs increase annually, and

New fees and penalties take effect next year, and most employers don’t fully understand how this will affect their financials.

It is time for employers to examine the specifics of healthcare reform, and start thinking strategically vs. emotionally. Change is hard. However, employers that educate themselves and plan ahead can avoid severe financial impacts.

The more change and disruption your business can embrace, the more cost savings (for both the company and your employees) you will be able to realize over the long term. In order to embrace this change, you must be familiar with the key aspects of ACA. For many small businesses, the solution to healthcare reform is simple: Offer a “Business Expense Account” for Healthcare. A new vehicle, called a Healthcare Reimbursement Plan (HRP), allows employers to get out of the health insurance business, and simply give select employees monthly allowances to spend on their own health insurance policy in a state health insurance exchange.

Listed below are key ACA components to consider when choosing small business health insurance. 

Individual Health Insurance Tax Subsidies

Beginning 2014, individuals will have access to tax subsidies to buy private health insurance through the public exchange. These subsidies will be for those who enroll in a silver plan through the exchange. The subsidy caps the cost of individual health insurance at 2% - 9.5% of their household income if their household income is less than 400% above the federal poverty line. This equates to roughly $90,000 per year for a family of four.

Click here for more information on the premium subsidies.

Individual Health Insurance Tax Penalties

The  Individual Mandate  requires most individuals to purchase health insurance, or else pay a penalty on their tax return each year. The intention of the individual penalty is to reduce the "Free Riding" effect in the health insurance market (a free rider is someone who is healthy and does not purchase health insurance until they need it.

Click here for more information on individual tax penalties.

Small Business Health Insurance Tax Credits    

Small businesses with up to 25 full-time equivalent employees may qualify for a tax credit for offering employee health benefits. The credit is broken in to two phases. Phase 1 (2010-2013) includes a tax credit worth up to 35% of a small business’s health insurance costs.  Phase 2 (2014 and beyond) includes a tax credit up to 50% of a small business’s health insurance costs.

Click here for more information the tax credits.

Small Business Health Insurance Tax Penalties

Starting January 1, 2015, Employers  with 50 or more  full-time equivalents who do not offer minimum essential coverage can face monthly penalties if at least one employee uses a premium tax credit to obtain health insurance through the state health exchange. If you do not have more than 50 employees, you are not subject to these penalties.

Click here for more information on the business tax penalty.

The Future of Small Business Health Insurance - Defined Contribution Plans

Defined Contribution Plans  allow employers to offer health benefits without offering a traditional group health insurance plan. Instead of paying costs for a specific group health plan, employers allocate tax-deductible monthly allowances for their employees to spend on private health insurance and other medical expenses tax-free.

Features of defined contribution plans include the following:

Employee Choice – employees choose a health insurance plan that best fits their needs.

Fixed Cost – employers control health care costs by allocating fixed monthly allowances for their employees.

Savings – employers using Defined Contribution Plans typically cost less than group health plans which results in saving for both the employer and employee.

Next Steps – Evaluate Your 3 Core Options

Immediately compare the costs and benefits of the following three options:

Offering a Defined Contribution Health Plan that Reimburses Employees for Individual Health Insurance Coverage, and

Offering Nothing.

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Pennsylvania Health Insurance

Affordable pennsylvania health insurance quotes.

Pennsylvania Self-Employed Health Insurance Plans And Rates

 Pennsylvania health insurance plans for the self-employed and small business owners are very affordable. Starting your own business does not mean you have to take the risk of being uninsured. There are many options for buying high quality medical coverage. We represent the very best health insurance providers in the state, such as Highmark Blue Cross Blue Shield, Independence Blue Cross, Keystone, Aetna (Coventry), UnitedHealthcare, UPMC, Capital Blue Cross, Ambetter, Oscar, and Geisinger.

Often, premiums for medical, dental, and long-term care coverage can be tax-deducted, with low rates for additional dependents. The benefit is offered regardless if you itemize, since Page 1 of the 1040 form is used. Also,the AGI will reduce.

We assist you in finding, comparing and applying for quality medical coverage that stays within your budget. Often, it can be quite challenging if you are an independent contractor or have to find and pay for your own policy. With more than 40 years of experience and expertise, we help simplify the process, by researching all available plan options that can help you. Enrollment often takes less than 15 minutes, and there are no fees or costs. Association plans may also be available, although they generally charge fees.

Depending on existing medical conditions, and household income, you can customize benefits to match your budget. Freelancers, independent contractors, and consultants can also qualify for guaranteed coverage with the possibility of tax credits to help lower the premium. If you have a single employee (or more), the SHOP Marketplace can also be considered. Note: If your spouse is offered group benefits, you may not be eligible for a tax credit to help pay for an Exchange plan.

Under-65 plans allow self-employed persons to deduct 100% of the policy premiums from your adjusted gross income (AGI). To qualify, you must have a net profit from your business (Schedule C, Schedule C-EZ, Profit Or Loss From Business, Net Profit From Business or Schedule F). You may also qualify for the deduction if you used an alternative option to calculate your Schedule SE earnings. Sole proprietors and independent contractors can also benefit from current tax laws. If you have payed contractors via 1099, specific options may be offered.

Self-Employed Healthcare For Seniors

Many Medigap options (Advantage, Supplement, and Part D prescription drug) are offered for Seniors that are eligible for Medicare. A high-deductible (HD) Plan G with lower premiums is also offered. The current deductible is $2,300 with 100% coverage after the deductible is met. Plan F (HD) is also available for policies issued before 2021. More information is provided below.

If you are a retiree (under age 65) and are receiving a pension from an employer, you may still enroll for a Marketplace plan. However, the full retail price will have to be paid since a subsidy would not be available. Pre-existing conditions will be covered with no waiting period.

A healthcare sharing ministry, although available in most areas, may not provide the appropriate guaranteed benefits that you should have. The “shared box” concept is more popular with applicants under age 65. However, payment of benefits is not guaranteed, and several states are currently investigating Ministry plans.

Pa Health Savings Accounts

Perhaps the most popular and cost-effective option is to purchase a Pennsylvania Health Savings Account (HSA). Although most self-employed residents are not aware of HSAs, this type of coverage will reduce your premiums, and allow you to save for future medical expenses on a tax-free basis. You can also terminate the policy at any time and change to a different type of plan. You never lose any accumulated money since it is always available. Deposits can be variable and also stopped or started at any time. Medical bills are easily paid online or at the location of treatment.

Funds can be quickly withdrawn, and lump-sum deposits are also accepted. When you become Medicare-eligible, although additional deposits are not allowed, accumulated funds can be used for approved expenses. It’s also possible that one adult family member will be covered through a Medigap Supplement plan, while the younger spouse continues coverage through an under-65 HSA.

A high-deductible Medicare Supplement option is also offered to Seniors (Plan F HD). The current deductible is $2,300 (see more information below). Previous unused HSA contributions can be used to pay for qualified Senior expenses. Premiums for long-term care plans can also be paid with accumulated deposits.

Many of the large insurers in the state offers this type of policy, which can reduce your tax liability. A group plan may be available, depending on the number of employees and the percentage of participation. But beware. Often, group costs are significantly higher than private rates since the availability to shop plans is sometimes limited. However, if your employer is paying 40% or more of your premium, you’re probably getting a good deal. Many larger companies will contribute up to $3,000 towards their employee’s HSA. Annual check-ups and preventative visits are covered with no out-of-pocket cost.

Policies are no longer medically-underwritten, so approval is virtually guaranteed. If you employ less than 25 employees, tax credits may be available up to 50%. However, it is very possible that net costs will be higher. This may be one of the main reasons that some employers are changing employee status from full-time to part-time, so they are not forced to purchase coverage. In those scenarios, the employee can qualify for a federal subsidy, depending on household income.

If you have more than 50 employees, you must furnish medical benefits to your workers. This “mandate” began four years ago and was part of the Affordable Care Act (Obamacare) legislation. Employees that work an average of 30 hours are considered “full-time.” Oddly, the news was originally broken in a Treasury notes blog . Although employees often pay a much lower premium for their group healthcare coverage, dependents may not be so lucky. Often, their rates are significantly higher, since the employer may not be paying any of the premium.

What is an HSA?

An HSA is an alternative to traditional insurance. They allow you to pay for current medical expenses, and potentially accumulate money in a tax-favored side fund. You own, manage and invest your money and decide how funds are dispersed. We have devoted an entire page here to this type of contract. You can compare the lowest priced offers at any time on our website, and on and off-Marketplace plans can be viewed.

A catastrophic medical insurance plan is created with the HSA. Although this policy will pay for preventative coverage at 100%, most other expenses are subject to a deductible. You can choose from a wide range of deductible options. Each year, the maximum-allowed amount can change. Currently, it is $6,900 per person (maximum of two per family).

Pennsylvania HSA plans also provide Network-negotiated repricing discounts that will reduce your out-of-pocket costs on expenses that are subject to a deductible. These discounts can be quite substantial, especially for lab tests and X-rays. For example, a typical lab test that costs $150 could be discounted to about $25, or less. An X-ray charge may reduce from $200 to $50. The cost of an MRI may reduce from $1,500 to $700. That’s a lot of savings! Often, you can shop different providers for the best pricing.

NOTE: there are many laws and regulations that self-employed persons must be aware of. Legislation often changes and the cost of maintaining and operating a business will fluctuate. The Pa IRS Small-Business Web Page provides free information regarding state agencies, general services that are offered, and Department of Labor and Industry links. Several carriers may offer small-business medical plans that require only two employees.

How much does a “high-deductible” (non-HSA) plan cost?

Rates vary, depending upon where you reside, ages of persons to be covered, the carrier, and your household income, since a federal subsidy is available. We have illustrated below several scenarios along with the monthly cost of coverage:

40-year-old married couple living in Allegheny County with household income of $40,000

$70  – UPMC Advantage Bronze $6700/$0

$118  – Highmark Together Blue EPO Bronze 3800

$298  – Highmark Together Blue EPO Silver 3450 HSA

50-year-old married couple living in Dauphin County with household income of $65,000

$51  – Geisinger Marketplace All-Access HMO 40/80/8400

$53  – Capital Blue Cross Bronze PPO 8000/0/50

$480 –   Capital Blue Cross Silver PPO 6000/20/40

55-year-old married couple living in Montgomery or Philadelphia County with household income of $50,000

$79 – Independence BC Personal Choice EPO Bronze Reserve

$94 – Ambetter Essential Care 1

$191 – Independence BC Personal Choice PPO Bronze

40-year-old married couple with two children living in Montgomery or Philadelphia County with household income of $82,000

$370 – Independence BC Personal Choice EPO Bronze Reserve

$384 – Ambetter Essential Care 1

$472 – Independence BC Personal Choice PPO Bronze

High Deductible Plan F For Seniors (HDF)

A “high-deductible” Medicare Supplement Plan (HDF) is also available for Seniors. The annual deductible is $2,300. The benefits are identical to regular Plan F, although the deductible must be met before covered expenses are paid in full. Applicants with no major medical conditions that have reached age 65 should consider Plan F (HD). Companies that offer this type of plan in the Keystone State include Cigna, Americo, Medico, Mutual Of Omaha, Continental Life, Independence Blue Cross, Humana, Highmark, and New Era Life. Female monthly rates are shown below for the largest counties in the state:

Philadelphia County

$49 – Americo

$50 – New Era Life

$50 – Cigna

Allegheny and Westmoreland Counties

$41 – New Era Life

$45 – Cigna

$45 – Americo

Bucks And Montgomery Counties

$44 – Americo

Lancaster, Berks, Lehigh, Luzerne, Dauphin, Erie, Cumberland, Lackawanna, Northampton, and York Counties

$34 – New Era Life

$40 – Americo

$41 – Cigna

Chester County

Other Options

Another option that will substantially reduce premiums is a “catastrophic only” policy. Coverage is limited to major medical items, but rates are generally hundreds of dollars less (per month) than a conventional comprehensive policy. Preventive benefits are still covered at 100% on this type of policy. Although prescription coverage is limited, the savings in premium usually offsets the lack of benefits. NOTE: Unless you are under age 30, you can not apply for this policy on the Marketplace.

Ideally, the perfect candidate is a young person (or couple) that is just starting a business. Bronze-tier plans should also be considered. Shown below are the “catastrophic” plans offered in Pennsylvania. Availability is determined by your county of residence.

UPMC Advantage $7,900/$0 (Partner, Premium, and Select Networks)

Highmark BS my Direct Blue Major Events EPO 7900

Geisinger Health Plan Marketplace Value

Independence Blue Cross Personal Choice

US Small Business Administration

The SBA offers many programs and has two Pa district offices. Their locations are in King Of Prussia (Parkview Tower 1150 First Avenue) and Pittsburgh (411 Seventh Avenue). Services provided include financial assistance through guaranteed loans for established and new companies, loans for veterans, free counseling and advice, loan programs for international trade companies, free services through Small Business Development Centers (SBDC) and help to companies that are owned by economically and socially disadvantaged persons. Self-employed healthcare information can also be found through several government websites that are provided to consumers.

Pennsylvania Small Business Development Centers (SBDC)

SBDC is an accredited organization that offers training, consulting, and many other resources for new and estatblished companies. They partner with the US Small Business administration and have 18 centers in Pennsylvania. University locations include Penn State, Pitt, Temple, Lock Haven, Clarion, Lehigh, Bucknell, Duquesne, and several others.

Pre-business and planning seminars are provided along with marketing and promotion, accounting, strategic planning, and human resources help for established businesses. Environmental management assistance is also provided, if applicable. Not-for-profit businesses are not eligible for assistance from SBDC. Managaement and training is provided at no cost. Expenses are paid by the SBA, and several government agencies.

If your priority is to pay as little as possible, but still protect you and your family against a serious accident or chronic illness, this is a good choice. Of the new Metal policies that will be offered on the State Exchange, the Bronze option would be the closest fit to a catastrophic policy. You may be able to purchase coverage separately from the Marketplace although you would not be eligible for a federal subsidy. However, if you are a high-income earner, you would not be losing any savings.

We work with self-employed business owners and small and large companies every day and we’ll find high quality health care at the lowest available rate offered by each carrier. To compare the best choices, please provide your zip code at the top of the page. You can also call or email us.

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Pennsylvania Health Insurance for Small Businesses

Pennsylvania group health insurance options include the following., for quotes on any of these health insurance companies that we recommend, please contact us at 412-352-7746 or complete the form below for further information..

NASRO of Pennsylvania is a private non-profit employee benefits organization specializing in helping companies, small businesses and non-profits  manage their health insurance and employee benefits, maximizing your options and getting you the most affordable rates possible.

As an independent exchange committed to the highest ethical standards, NASRO provides Pennsylvania with easy-to-understand coverage and rate comparisons, transparent plan details, expert advice and free quotes.  Why rely on cumbersome government web sites or heavily biased health plan web sites. NASRO is your smart source for access to the health insurance plans that fit your company, provide the best value, and deliver quality health care. Call 412.352.7746  for a group health insurance quote, or use our quote request form below.

NASRO supports Medicare For All 

NASRO of Pennsylvania is a non-profit that has been helping the community achieve access to affordable health care for over 28 years. We have led the way for small businesses to join the vibrant coalition of health care providers and religious activists who broke through the resistance of the health insurance industry to require universal health care access in Massachusetts. From the Massachusetts Landmark Health Care Reform law came the federal Affordable Care Act .  Let NASRO provide your business with the clear, factual answers you need to operate in today’s health care world.

Is your health insurance agent knowledgeable enough to keep up with  Pennsylvania  health care reform?

NASRO is a non-profit, founded by health care consultant and activist Robert Gaw, with only one agenda — helping your organization secure the affordable, high quality health care coverage you need for your company.  NASRO is your advocate and a humanitarian organization for the common good, as well as a trusted independent organization experienced in helping companies find the way through today’s health insurance confusion. We can also administer your plan to assure ongoing quality and responsive service from your plan and the providers who contract with them.  And with NASRO, there are no complicated web sites and no waits for impersonal service from out of state or overseas telemarketing centers.

Contact NASRO Today to Learn More and Get More

The Affordable Care Act has raised the bar in terms of greater protections for the health care provided to you, your employees and their families. But that does NOT mean all health plans in Pennsylvania are equal. We at NASRO offer the best, most appropriate health plans available, at the best rates.  Call us today at 412-352-7746 or complete the form below for additional details and a custom quote.

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Small Business Health Insurance in Pennsylvania

Pennsylvania is a state of small businesses, boasting over one million local small businesses, which forms over 99 percent of its business economy. However, despite this, not many Pennsylvania small business owners offer Small Business health insurance plans to their employees because of the ever-increasing costs of these policies, with premium costs rising around 113 percent for the past decade.

But with the increasing demands of employers and employees alike, there are now different types of health insurance for small businesses that are cost-effective. It allows small business owners in Pennsylvania to ensure they and their team acquire the proper coverage for their medical needs in the event of a sudden sickness spreading or accidents without having to pay large sums of money.

To make it easier for you, here is a definitive guide about Small Business health insurance plans in Pennsylvania, helping you determine which is the best health insurance plan for your business.

Pennsylvania Small Business Insurance Health Plans: How Does it Work?

When you purchase a health insurance plan for your company and employees, you typically pay an insurance company or carrier a monthly premium fee to protect you and your team when medical bills come up.

Here are the four things that every employer should know about Small Business health insurance:

Coverage is Usually a Guaranteed Issue

First, if you are qualified to have a company health plan, your coverage is typically issued by the insurance carrier. This factor means that these insurance providers cannot turn down you, your employees, and their dependents for coverage based on pre-existing medical conditions. All eligible full-time employees of your small business and their qualified dependents can enroll in the new plan regardless of their medical conditions.

You Need at Least One Full-Time Employee to Qualify

For you to be eligible for any Small Business health insurance plan, you need to have at least one full-time employee, and this doesn’t include you and your spouse that may be working for your company. Although the rules vary from each state and different insurers, that is usually the general requirement. You can ask your local government and insurers in Pennsylvania for more information.

You Need to Contribute Toward Employee Premiums

Besides having the right number of employees, you need to pay at least 50 percent of their monthly insurance premium costs. However, the minimum percentage can also vary by state and insurers. You can also contribute towards the premiums for your employees’ dependents. Consult with your local government and insurance carriers in Pennsylvania for more information.

You Can Buy Coverage at Any Time of the Year

As an employer, you can shop for health insurance coverage anytime you like, you don’t need to wait for a particular open enrollment period. However, keep in mind that once you purchase health insurance plans, your premiums are locked in the whole year, and you can add new employees and dependents to the policy as you like. You can also drop coverage for people that no longer work for you. An employer can renew insurance coverage or shop for a new plan by the end of the year.

Types of Small Business Health Insurance Plans

Here are the most common insurance coverage options that you can choose from:

Health Maintenance Organization

The HMO plan provides a cheaper and comprehensive health plan with lower out-of-pocket costs. However, you are limited to choosing healthcare providers and facilities in-network (providers selected by the insurer of your choice) to avoid additional fees. Each member under the plan is required to select PCPs (Primary Care Physicians) included in the list of the providers from the insurer, and they need referrals from the PCP if they need to see a specialist.

Out-of-pocket costs are limited to low co-payments for physician visits, yearly deductibles, and other covered services, making the additional costs minimal to non-existent. The vastness of providers in the HMO network will vary by location.

Preferred Provider Organization

The premium costs for a PPO plan are more expensive than the standard HMO plan, but it offers you vast networks to choose from, giving you more flexibility and choices. Members under this plan are not limited to selecting in-network PCPs, and they don’t need referrals to see a specialist. They are allowed to choose any healthcare provider or facilities regardless of whether these providers are in the plan’s network. Still, the costs may be higher for out-of-network services.

The out-of-pocket fees that members have to pay for themselves include co-payments for doctor consultations, annual deductibles, and other medical services.

Point of Service Plan

The POS plan is a combination of the PPO and HMO policies and is mid-range between the two. The POS network will vary by each state. Members are required to choose an in-network PCP for their medical services, but they don’t need a referral to see a specialist to receive benefits included in the POS plan. Although members can go outside the network for other services, it is a bit more flexible than an HMO plan.

The out-of-pocket fees that members under a POS plan are minimal compared to members under a PPO plan, as they only pay a small portion of the covered services.

You can consult with a licensed insurance agent for more information to help you find the best coverage options and plan that’s best for you and your workers.

Pennsylvania Health Insurance for Companies Coverage

The ACA (Affordable Care Act) requires all health plans to provide minimum essential coverage, including:

Preventive Care

All employees’ and employers’ annual physical screenings, immunizations, and any other consultation required to ensure you are healthy.

Emergency Services

The plans cover all trips to the ER (Emergency Room) and ambulance rides.

Maternity Care

Care received for female employees or employers before and after their baby is born.

Testing that helps a physician diagnose illnesses and injuries or monitor the effectiveness of their implemented treatments.

Prescription Drugs

The insurance plans cover all medications prescribed by a physician to treat medical conditions and illnesses.

Ambulatory Patient Services

All care received outside of a tertiary healthcare facility, including the doctor’s office, outpatient surgery center, emergency room, or home health services, is covered by the health plans.

Hospitalization

The insurance plans cover all you receive inside healthcare facilities, including doctors, lab tests, room, board, medication, surgery, labor, delivery, transplants, and more.

Rehab Services

The plan should cover all care and equipment fees that help you recover from injuries, disabilities, and other severe conditions. These can include physical therapy, psychiatric rehabilitation, occupational therapy, and speech-language pathology.

Mental Health and Substance Abuse Services

It covers outpatient and inpatient evaluation, consultation, treatment of all mental health, and substance abuse conditions.

Pediatric Services

It should cover all vision and dental care for children younger than 19 years old, including at least two dental cleanings, one set of appropriate lenses, and one eye exam.

Benefits of Pennsylvania Health Insurance for Company

The following are the advantages that employees and employers can enjoy when having a company health insurance:

Have Access to Quality Medical Care

Health insurance plans provide employers and employees with access to a network of physicians, hospitals, pharmacies, and other healthcare providers covered under your insurance plan. They provide you with the right treatment with no additional charges or entirely free (depending on the policy you choose). You can ask your Pennsylvania insurer for more information.

Tax Deductible Premiums

Health insurance premium fees on small business plans are all tax-deductible for the employees and the company, reducing the cost of coverage by 25 to 50 percent.

Small Business Tax Credit

Small companies with fewer than 25 full-time equivalent employees and payroll costs of less than $50,000 per worker can qualify for an additional tax credit of up to 50%.

How to Become Eligible for a Small Business Health Insurance Plan

Because of the benefits that health plans provide for small businesses over individual coverage, insurance companies require that these smaller firms meet several requirements to verify their eligibility first.

Most providers look at the following to determine if you are qualified:

• Be registered as an official firm in your home state
• Have at least two workers working for over 30 hours per week at the company, with one W2 employee besides the owner
• Have clean and detailed history records for salaried workers and tax or ownership documents for company owners or employers

Qualified Employees for Small Business Health Insurance Coverage

The following eligibility criteria ensure your employees are eligible for the health plans:

They Work Full-time Hours

Full-time work hours are when you are working for a company for over 30 hours per week, but in some states, employers can offer coverage to part-time employees that work less than 20 hours weekly.

Employed as a W2 Employee

In most states, 1099 contractors (individuals who work independently rather than for an employer) are not qualified to be covered under health insurance plans. However, if 1099 contractors work for over 30 hours per week, they can be eligible for company coverage.

You have worked hard to grow your company, and if you want to keep the top talent that you already have, it’s best to invest in health insurance plans to keep your Pennsylvania business stand out among the rest. Choose the best health plans that can contribute to the growth of your enterprise.

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Pennsylvania Business Insurance

This guide covers Pennsylvania business insurance requirements, costs, and types. Business insurance protects your business’s assets from natural disasters and lawsuits from employees, customers, or other businesses.

In addition, all Pennsylvania businesses with one or more part- or full-time employees must carry workers' compensation insurance under Pennsylvania law. 

Recommended: Get the protection you need in Pennsylvania with a dedicated small business insurance provider like Next Insurance .

Business Insurance in Pennsylvania

Getting the right business insurance is easy with the right insurance provider. Learn more about business insurance and our recommended providers below.

To research business insurance requirements in other states, visit our guide .

Pennsylvania Business Insurance Requirements

The State of Pennsylvania requires certain types of business insurance. Like most states, workers’ compensation insurance is required for businesses with employees. Or the business can apply for self-insured status. 

Pennsylvania also requires unemployment and disability insurance for employees depending on hours worked and compensation.

How Much Does Business Insurance Cost in Pennsylvania?

The most accurate way to determine insurance costs is to get a quote from a trusted provider. Some insurance providers specialize in small business insurance, which helps reduce costs. 

According to a recent US small business study, you can expect to pay (on average):

• General Liability: $65/month 
• Business Owner’s Policy: $99/month 
• Professional Liability (E&O): $97/month
• Workers’ Compensation: $111/month

Find the Most Affordable Coverage

Visit our Cheapest Business Insurance review to find the best coverage at the lowest rate.

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Types of Pennsylvania Business Insurance

When starting a business in Pennsylvania, it's important to understand the types of business insurance available to you. Here are the most common policies:

General Liability Insurance

The vast majority of Pennsylvania companies purchase general liability insurance from an insurance company even though it is not legally required. This type of business liability insurance covers third-party bodily injury, third-party property damage, advertising liability, libel, slander, copyright issue, and other common claims faced by companies across various industries. 

General liability insurance is one of the most important types of business insurance your company can purchase.

Business Owner’s Policy

A business owner’s policy (BOP) is an affordable way to bundle business insurance coverages. This type of policy includes commercial general liability insurance with commercial business property insurance. Many small business owners with a physical business space opt for this coverage.

Commercial Auto Insurance

You need to carry commercial auto insurance if your company uses vehicles to transport people or goods. This type of insurance is very similar to personal auto insurance and covers liability, medical costs, collisions, and uninsured/underinsured motorists. A commercial auto policy also covers vehicles rented or owned by your company and employees who use their own vehicles for company business.

Workers’ Compensation Insurance

Pennsylvania requires businesses with employees to carry workers’ compensation insurance or be self-insured. These policies cover employees who are injured or get sick while at work. Covered costs include medical expenses, lost wages, and death benefits. Coverage is provided for this “no-fault” insurance regardless of whether the employer caused the injury or illness.

Employee Health/Life/Disability Insurance

Companies that provide health, life, and/or disability insurance as a fringe benefit will need appropriate Pennsylvania insurance. Under the Affordable Care Act, firms with more than 50 full-time employees must offer health insurance or pay an expensive penalty.

Professional Liability Insurance

Professional liability insurance covers financial risks to attorneys, accountants, and other people who provide professional services or expertise. Professional liability coverage varies depending on the industry but usually includes negligence, legal defense, slander or libel, and copyright and trademark disputes. 

Professional liability insurance includes errors and omissions (E&O) insurance.

Data Breach Insurance

If your company hosts customers’ personal information on its servers and those servers are hacked, lawsuits and damages can result. Data breach insurance protects you in these cases. 

Cyber Liability Insurance

Similar to but more comprehensive than data breach insurance, cyber liability insurance may pay for legal expenses related to a data breach or set up a call center for individuals affected by a breach. It also may pay for active protection against cyberattacks.

Commercial Crime Insurance

Crimes like extortion, forgery, burglary, computer fraud, and embezzlement are covered by commercial crime insurance. Situations in which this type of insurance is particularly useful include dishonest or libelous acts by employees.

Fiduciary Liability Insurance

Fiduciaries, who are legally required to act in plan participants’ best interests rather than the company’s when choosing advisors and investments, should consider this type of insurance coverage. It covers them if they are sued for allegedly providing negligent investment advice or administering plans or benefits incorrectly. 

Third parties like out-of-company consultants and benefit plan administrators are usually not protected.

Directors and Officers Insurance

Any company with directors and officers should consider directors and officers (D&O) insurance coverage, a type of liability insurance that reimburses directors and officers for claims made against them regarding harm allegedly caused by their management decisions.

Executive Risk Coverage

Executive risk insurance is business liability insurance that provides coverage for fraud, D&O, employment practices, initial public offerings, pension funds, extortion, and professional negligence.

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How to Get Business Insurance in Pennsylvania

There are four basic steps to getting business insurance:

Assess Your Risk

Consider what risks, natural disasters, and lawsuits your business might be prone to. This will help you get the right insurance coverage.

Get a Quote

It’s challenging to compare quotes because the policies will have different coverages and different prices — and it’s hard to compare apples to oranges. We recommend keeping it simple with two quotes from providers you trust.

Review and Purchase

Review the terms of the policy and make sure the coverage meets your needs. The cost of the policy should be a secondary consideration because if you don’t have the right coverage, what’s the point?

Gather Your Information

You’ll need information on your business property, including leases, construction, and square footage. For vehicles, you’ll need mileage, title, registration, and the names and copies of the driver’s licenses of employees that will be driving them.

Your insurance company will need the names and social security numbers of employees and owners. Bank records may also be requested as well as contact information for your CPA and/or attorney.

Pennsylvania Small Business Data

According to an SBA survey , 1.1 million Pennsylvania small business owners employ 2.5 million people who comprise 46.3% of the state’s private-sector workforce.

The most populated cities in Pennsylvania include Philadelphia, Allentown, and Pittsburgh, which may be good places to establish a business in the state.

Professional, scientific, and technical services; construction; and retail trade are the largest small business employers in Pennsylvania, according to the latest data available from the SBA.

Pennsylvania may not be the best state for business. The economy relies heavily on the agricultural sector, which makes it prone to volatility. In addition, both the cost of living and the cost of doing business are high. In a recent survey, the state ranked 39th for business friendliness.

Pennsylvania Business Insurance FAQ

Am i required to purchase workers’ compensation coverage in pennsylvania.

In Pennsylvania, if you hire employees, you are legally required to purchase workers’ compensation insurance or obtain Pennsylvania Department of Labor & Industry approval to self-insure.

How much does business insurance cost in Pennsylvania?

How much business insurance in Pennsylvania will cost for you will depend on several factors:

• How many coverage policies are you purchasing?
• What types of coverage policies are you purchasing? Some are more expensive than others.
• What’s your risk profile? Have you been involved in other claims or settlements in the past?
• How liquid is your business?
• How risky is your business’s industry?

Generally speaking, you will need to request a quote from your preferred insurance provider for each insurance policy. They will be able to assess your business’s specificities and give you an accurate estimation of your monthly or annual fees.

Why do I need business insurance?

Business insurance helps protect businesses from costs associated with liability claims and property damage. Some states require certain types of business insurance.

Business insurance not only protects your business — it protects your employees and customers too. It provides peace of mind and can add credibility to your business. Many contracts require business insurance, as well.

What kind of insurance do you need to run a business?

Business insurance requirements vary by state. In Pennsylvania, businesses with at least one employee must have workers’ compensation or be self-insured. 

In addition, unemployment and disability insurance is required for Pennsylvania employees depending on the number of hours worked and compensation. However, this is something that you will pay as a tax to the state and not something you obtain from an insurance provider.

How do I get a certificate of insurance for my Pennsylvania business?

You can get a certificate of insurance by starting a policy with an insurance provider. 

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• Small Business Insurance

Best Health Insurance Companies for Small Businesses

Blue Cross Blue Shield shines for availability and its wellness programs

We independently evaluate all recommended products and services. If you click on links we provide, we may receive compensation. Learn more .

When it comes to health insurance coverage, a small business is generally considered an employer with one to 50 employees, excluding the owner, their spouse, and any family members. However, some states and private companies include businesses with one to 100 employees in their definition of a small business. You can use the Small Business Health Insurance Options Program (SHOP) to find ACA-compliant group plans, which you can offer to employees by purchasing coverage with help from an agent or broker. A SHOP plan is the only way to qualify for the Small Business Health Care Tax Credit if you meet the eligibility requirements. If you can’t find a plan on the SHOP marketplace, you can find one directly through insurance company websites.

If you offer SHOP coverage, you must offer it to all full-time employees and have an office or worksite in the state where you’re applying for coverage. Not all providers offer SHOP plans, and they may not be available everywhere. Whether you decide to enroll in a SHOP plan or another group health insurance plan, you’ll want to choose a reputable company that prioritizes your employees and their healthcare needs. We evaluated companies based on the benefits they provide and their third-party ratings, so you can choose the right health insurance partner for your small business.

• Best Overall: Blue Cross Blue Shield
• Best for Telemedicine: Oscar
• Best for Customer Satisfaction: Kaiser Permanente
• Best for Extra Benefits: UnitedHealthcare
• Best Self-Insured Plans: Aetna
• Our Top Picks

Blue Cross Blue Shield

Kaiser Permanente

UnitedHealthcare

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Final Verdict

Methodology, best overall : blue cross blue shield.

Nationwide availability

Wide provider network

Offers a variety of workplace wellness programs

Blue365 provides employees with discounts on health products and services

J.D. Power rating varies by region

With coverage in every U.S. ZIP code and a variety of national networks to choose from, Blue Cross Blue Shield can meet the needs of almost any business. The company was also our top pick for the best health insurance provider overall. But since BCBS is a group of companies, benefits vary by region, as do customer satisfaction ratings. It’s important to evaluate your BCBS company for issues like customer complaints. 

BCBS workplace wellness programs vary by state, but as an example, BCBS Mississippi trains company leaders to teach fitness classes, and offers a significant reduction in health insurance premiums for employees who commit to working out at least twice per week. Other benefit offerings vary by region as well, but Anthem offers 24/7 virtual care, a convenient mobile app, a variety of plan types, and the option to bundle health coverage with dental, vision, life, and/or disability insurance. And the Blue365 discount program provides your employees with robust discounts on wellness-related products and services.

Best for Telemedicine : Oscar

Oscar Insurance

$0 virtual urgent care available 24/7

Access to Cigna’s network with no referrals needed

A convenient mobile app with rewards for walking

Limited geographical availability

Oscar makes it easy for your employees to request virtual care from a convenient mobile app, and with most plans, there’s no cost to talk to a doctor online. Employees can also use the app to refill their prescriptions, message their care team, track their deductibles, and even get rewarded for meeting their step goals. What’s more, Oscar has partnered with Cigna to give members access to the company’s national and local provider networks. You can give your employees two network options, both of which don’t require specialist referrals and which include the Cigna Behavioral Health Network. 

However, availability is limited to a few different states, cities, and metro areas: Georgia, Tennessee, Connecticut, select Arizona counties, select California counties, the Philadelphia metro area, Kansas City, Chicago, and St. Louis.

Best for Customer Satisfaction : Kaiser Permanente

Ranked highly by J.D. Power for customer satisfaction

4.3-star NCQA rating

Administers health payment accounts (HRA, HSA, or FSA) for deductible plans

Offers complementary care, vision, and dental plans

Kaiser Permanente received the best third-party member experience ratings of any insurer we reviewed. Its average NCQA rating is 4.3 stars (higher than all other providers). And it came in first for customer satisfaction in five of 22 regions—this is significant because it’s only available in eight states and Washington D.C. What’s more, Kaiser offers a range of health plan options, from PPO plans to deductible HMOs that can be paired with a health savings account or health reimbursement arrangement. And it’s affordable to add extra benefits for your employees, which include not only dental and vision, but also complementary care, such as acupuncture and chiropractic. 

However, Kaiser Permanente plans are only available in California, Colorado, Georgia, Hawaii, Maryland, Virginia, Oregon, Washington, and the District of Columbia. And while the company provides resources and support for establishing a workplace wellness program, Kaiser is less hands-on than some Blue Cross Blue Shield companies when it comes to specific workplace programs. The company does, however, offer a variety of fitness discounts, and members can speak with a wellness coach at no cost.

Best for Extra Benefits : UnitedHealthcare

Offers a variety of extra benefits beyond just vision and dental

Offers options for part-time and seasonal workers

A+ (Superior) financial strength rating with AM Best

Customer satisfaction varies by region

UnitedHealthcare allows you to offer employees a variety of choices for plan types. It even provides bundled savings when you choose to offer additional coverage, such as vision, dental, hearing, and disability and absence benefits, plus supplemental, pet, and life insurance benefits. UnitedHealthcare also offers a unique program designed for part-time and seasonal workers, which is the only such program available nationwide. Level-funded and fully insured options are available for traditional major medical coverage, and a lower-cost, level-funded, limited minimum essential coverage option is also available. In addition, UHC offers a variety of workplace wellness programs, including a no-cost virtual weight loss program and rewards for physical activity. Group health plans include a discount program as well.

UnitedHealthcare also boasts relatively strong third-party ratings, with an average NCQA rating of 3.5 stars and an A+ (Superior) financial strength rating from AM Best, the highest grade of any of the featured providers on this list. However, the company’s customer satisfaction rating in the J.D. Power 2022 U.S. Commercial Member Health Plan Study varies by region. For example, the company was ranked lowest (out of seven providers) in Florida, but ranked second in the Heartland. 

Best Self-Insured Plans : Aetna

Offers self-insured funding options

Offers a suite of more than 70 wellness programs

Dedicated support for new business onboarding

$0 MinuteClinic copays for self-insured members

MinuteClinic benefits not available to fully-insured groups in some states

If you’re looking for more plan flexibility and the possibility of greater savings, Aetna is our top pick for self-insured funding options. Self-funding with Aetna can save you as much as 25% on monthly costs, plus the insurer returns 50% of the surplus to your business. At the same time, stop-loss insurance protects you from unaffordable costs. HSA accounts are also available to employees, as are $0 copays for many MinuteClinic services. Just keep in mind that some fully-insured groups don’t get the same benefits. 

Aetna also offers a suite of tools to members of self-insured plans, including a convenient mobile app that can provide rewards for reaching personalized goals, virtual care through Teladoc, and virtual fitness classes. The company also has an A (Excellent) financial strength rating with AM Best, and an average 3.3 NCQA star rating for its commercial plans, which indicates above-average member satisfaction. You can get group dental coverage through the provider as well. But Aetna’s group plans aren’t available everywhere.

Bear in mind that if you opt for self-insurance, you’ll be subject to IRS reporting requirements , regardless of your business size.

Blue Cross Blue Shield was our top pick all-around, and will be an especially good choice in regions where BCBS has high customer satisfaction ratings, robust workplace wellness programs, and other benefits. But if a convenient app with easy access to virtual care is most important to your employees, you may want to go with Oscar. And if you want the best customer experience for your employees, Kaiser is an excellent choice. 

We recommend Aetna for small businesses pursuing self-insurance, and UnitedHealthcare is the best option for businesses that want the most extensive benefits package, especially those who want options for their variable-hour employees. Your budget and location may also limit your choices, but our top picks are all reputable providers that offer good coverage.

Frequently Asked Questions

How do i get health insurance for a small business.

If you’re self-employed, check the best health insurance companies for self-employed workers. Otherwise, you have a couple of options: The first is to work directly with a private insurer to get a fully-insured or self-funded plan. The second is to compare plans offered through the Small Business Health Insurance Options Program (SHOP), and to purchase coverage directly or with help from a broker. 

While this program offers robust options in some states, others have limited or no plans available. Generally, getting SHOP coverage is the only way to claim the Small Business Health Care Tax Credit, which could save you up to 50% on your premium contributions. You must meet other eligibility requirements as well.

Do Small Businesses Have to Provide Health Insurance?

No employer is required to offer health coverage for its employees, but companies with at least 50 employees that do not offer health coverage are subject to the Employer Shared Responsibility Payment. If you choose to offer health insurance coverage to your full-time employees, you must offer it to all full-time employees once they become eligible, and there is a 90-day maximum waiting period.

How Much Does Small Business Health Insurance Cost?

Your total cost will depend on several factors, including the location of your business and the type of network you choose. In 2021, businesses with fewer than 200 employees spent an average of $6,569 per employee on annual health insurance premiums for single coverage and $14,094 for family coverage. Experts generally recommend keeping group health insurance costs between 10% and 20% of your annual revenue. 

What Is a Self-Insured Health Plan?

A self-insured health plan is a type of group health insurance in which the employer collects premiums and is responsible for paying claims when employees need care. These plans can be self-administered, or the business may work with an insurance provider to get stop-loss coverage and administrative support. 

There are several benefits to self-funded plans. Employers can keep surplus premiums (or receive a portion returned by the stop-loss carrier), plans can be customized to a greater degree, and certain ACA provisions that lead to high costs can be avoided. Increasingly, small businesses are opting for self-funded coverage. But self-insured plans aren’t right for every business.

We compared the largest health insurers nationwide and considered criteria in the following categories to determine the best health insurance companies for small businesses.

• Customer satisfaction : We used NCQA ratings and performance in the J.D. Power U.S. Commercial Member Health Plan Study to measure this criteria. 
• State availability : This measure indicates how widely available plans are across the U.S.
• Plan features: For each company, we researched the types of plans available, plan features and benefits, the provider network, available wellness programs, and discounts.
• Types of employees covered: We considered whether coverage is available for full-time, part-time, and seasonal workers.
• Accessibility : We considered how easy it is for members to navigate plan services.

J.D. Power. “ 2022 U.S. Commercial Member Health Plan Study .”

KFF. “ Section 6: Worker and Employer Contributions for Premiums .”

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Best Small Business Health Insurance Providers Of 2023

Fact Checked

Updated: Jan 3, 2023, 1:56am

If you own a small business and are looking to attract—and keep—employees, providing health insurance to your workers may help.

Which health insurance company is the best for small businesses? The health insurance marketplace is vast, but we did the initial research for you and ranked the best health insurance companies for small business owners.

• Best Health Insurance
• Best Short-Term Health Insurance
• Best Affordable Health Insurance
• Best Dental Insurance Companies

Best Health Insurance Companies for Small Business Owners

Kaiser permanente, blue cross blue shield, unitedhealthcare, summary: ratings of health insurance for small business owners, how does small business health insurance work, small business health insurance options, small business health insurance requirements, average cost of health insurance for a small business, how to compare small business health insurance plans, methodology.

• Frequently Asked Questions (FAQs)

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Availability

8 states and Washington, D.C.

Provider network

39 hospitals and 734 medical facilities with 23,656 physicians

Telehealth offered?

Kaiser Permanente is a nonprofit organization that combines health insurance and the delivery of health services through integrated care so members get a “coordinated experience.” In addition to hospitals operated by Kaiser, its network includes doctors, pharmacies, labs, imaging and other services. This integrated approach has resulted in a very low level of complaints from members.

Kaiser Permanente is available in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington and Washington, D.C.

Kaiser’s Thrive Local is a referral system that connects members to non-medical and socioeconomic services they may need, such as services for a disability.

Read More:  Kaiser Permanente Health Insurance Review

50 states and Washington, D.C.

Varies by Blue Cross Blue Shield plan

Blue Cross Blue Shield (BCBS) is made up of 34 independent and locally operated health insurance companies. Members of certain BCBS plans can join Blue365 for free health and wellness discounts. There are discounts for fitness products, such as Fitbit, hearing and vision, such as Target Optical, and meal boxes from Freshly.

Members also get access to doctors and hospitals in more than 200 countries through Blue Cross Blue Shield Global Core.

Forbes Advisor’s analysis of all Blue Cross Blue Shield plans found that member complaints are generally low. Notable exceptions to this are in California, where Blue Shield of California has a complaint level that’s more than four times the industry average. Also, Anthem Blue Cross in California has twice as many complaints as the industry average. And Anthem Blue Cross and Blue Shield in New Hampshire garners almost five times the average number of complaints.

But for the most part, BCBS health insurance plans around the country deliver customer happiness and a large provider network.

49 states and D.C.

(not available in New York)

1.3 million physicians and care professionals and 6,500 hospitals and care facilities across the U.S.

UnitedHealthcare offers insurance coverage in nearly every state.

Beyond employer-sponsored plans, UnitedHealthcare also offers coverage through the Affordable Care Act plans, Medicare, Medicaid, short-term health insurance and supplemental insurance, including critical illness insurance.

Some UnitedHealthcare plans offer additional benefits, including $0 primary care physician visits and copays, unlimited virtual visits, adult vision and dental and prescription drug delivery.

Read More:  UnitedHealthcare Health Insurance Review

The Affordable Care Act (ACA) defines a small business as a group of no more than 50 full-time employees (FTE), though some states define it differently. California, for instance, categorizes small businesses as employers of no more than 100 FTE. Small business owners aren’t legally required to provide health insurance to their workers, but there are rules for those who do.

A small business owner enrolls in a group health insurance plan offered by a private insurance company and then offers their employees the opportunity to enroll in that plan. The employer pays part of their employees’ monthly premiums, and the employees are typically responsible for their deductibles, copays and services not covered by the plan.

Thanks to the ACA, small business owners can buy health insurance for their employees through approved insurance companies with the Small Business Health Options Program (SHOP). Getting insurance through the SHOP Marketplace allows employers to offer health plans from multiple insurance companies and qualifies them for the Small Business Health Care Tax Credit, which can help with the cost of providing coverage.

Your business must meet these requirements to qualify for the SHOP tax credit:

• Fewer than 25 full-time equivalent (FTE) employees
• Average employee salary is about $56,000 per year or less
• Pay at least 50% of your full-time employees’ premium costs
• Offer SHOP coverage to all full-time employees

Small business owners can also work with a health insurance broker who conducts all plan research and comparisons to find the best plan for your business at no additional charge.

Group plans for small businesses are organized by “metal” tiers:

Each tier features different premiums, deductibles, copays and out-of-pocket limits, catering to people who prefer to pay higher monthly premiums for more extensive coverage and those who’d rather pay a lower monthly premium and risk higher coverage costs in the event that they need to seek care. Employers have flexibility in which type of plans they choose to offer their employees.

Small business owners do not have to provide health insurance benefits to employees. Should they choose to do so, they must meet certain requirements set by the ACA below. These requirements can vary by state.

Inclusivity

Health insurance must be offered to all employees—not just managers or any other subgroup.

Coverage of essential health benefits

Under the ACA, a health plan offered by a small business owner must include coverage for basics, such as emergency services, pregnancy-related care and services, maternity and newborn care, outpatient care, prescription drugs and more.

Minimum contribution

The ACA requires small businesses to contribute at least 50% of the monthly premium cost of the plans they offer to qualify for the Small Business Health Care Tax Credit. In addition to these rules, states typically require a minimum percentage of employee participation in health insurance plans offered by small businesses, says Bruce Jugan, president of BenefitsCafe.com, an insurance broker in Montebello, California. “The reason behind this [rule] is if there are 10 employees in a company and only three enroll, it’s likely that those three are really sick.” To better distribute the costs, total enrollment should be a mix of individuals with varying health statuses.

The average cost for small business owners is $547 per employee per month and $1,175 for family coverage per month , according to Kaiser Family Foundation’s 2021 Employer Health Benefits Survey.

The exact cost depends on multiple factors, including the type of plan, workers’ age and health status. A year of high employee health care costs could lead to higher health insurance rates set by the insurance company the next year.

How to Get Health Insurance for a Small Business

You have several options when it comes to searching for the right plan options for your small business:

Do your own footwork

Small business owners can sort through options from different insurance companies to compare prices and services and enroll in a plan that meets their needs. Most health insurance companies offer a number of plans for small businesses. By plugging a minimal amount of information into forms on their websites (your ZIP code and number of employees), you can see plan choices and costs.

Work with an insurance broker

Insurance brokers know the ins and outs of health insurance plans, as well as state and federal requirements. Just be sure you’re working with an independent or agnostic broker who will show you all plans available to you to best meet your needs.

Explore the SHOP Marketplace

At Healthcare.gov you’ll find helpful calculation tools and clear choices for high-quality group insurance plans.

Choosing a small business health insurance plan requires you to act similar to a consumer buying an individual health insurance plan on the Affordable Care Act marketplace.

Here’s what to look at when comparing small business health insurance plans:

Benefit design

See what types of health plans a company offers, including preferred provider organization (PPO) plans, health maintenance organization (HMO) plans and exclusive provider organization (EPO) . The benefit design dictates whether employees can get out-of-network care and need referrals to see specialists. One employee may like the lower premiums in an HMO and not have a problem staying in-network, while another may prefer the flexibility of a PPO with the understanding that they will pay more in premiums. Providing employees options can help with employee satisfaction.

A health insurance premium is what members pay to have coverage. This usually gets deducted from paychecks. Employers pay most of the premiums, so businesses will need to figure out how much coverage will cost them and their employees.

Out-of-pocket costs

Deductibles, co-insurance and out-of-pocket maximums play vital roles in how much members pay when they need health care services.

Major health insurance companies contract with providers and medical facilities like hospitals. These contracts decide how much providers get paid and may set requirements for providers, such as requiring that they meet a minimum quality of care. A small network could result in employees needing to search for a doctor and lead to extra out-of-network costs.

We analyzed health insurance plans to determine the best health insurance companies that offer coverage to small businesses. Forbes Advisor’s ratings are based on:

• Complaints made to state insurance departments (40% of score) : We used 2021 complaint data from the National Association of Insurance Commissioners.
• Plan ratings from the National Committee for Quality Assurance (30% of score) : The National Committee for Quality Assurance (NCQA) is an independent, nonprofit organization that accredits health plans and produces ratings based on specific metrics.
• Fitch Ratings credit ratings (30% of score) : We used the latest credit ratings for the best health insurance companies that offer group coverage to gauge their financial health.

Small Business Health Insurance FAQ

When does a small business have to offer health insurance.

​​Small business owners are not required by law to provide their employees with health insurance . With that said, make sure you understand how your state defines a small business, as it will impact what you are required to provide, should you decide to offer health insurance to your employees.

How much does group health insurance cost for small businesses?

The average annual cost of health insurance for small business owners is $6,589 per employee and employees pick up an average $1,244, according to Kaiser Family Foundation’s 2021 Employer Health Benefits Survey.

Small businesses pay less for health maintenance organization (HMO) plans than other types of health plans. Kaiser Family Foundation found small companies pay an annual average of $6,060 for HMO single coverage compared to $6,910 for a preferred provider organization (PPO) plan.

The Kaiser Family Foundation added that small companies are more likely to pay all employee premiums than larger companies. The report said 29% of covered workers in small firms don’t pay premiums for single coverage for health insurance. That’s compared to just 5% in large firms.

How many employees does a small business have to have to provide health insurance?

The ACA established that businesses with at least 50 employees must provide some level of health insurance . If they don’t, they have to pay penalties.

Can business owners buy a plan on the marketplace?

Small businesses can buy health insurance coverage for employees on the ACA marketplace through the Small Health Options Program (SHOP). SHOP lets employers compare plans and the Small Business Health Care Tax Credit can help save money for businesses.

• How To Get Health Insurance
• What You Need To Know About Group Health Insurance
• Your Guide To Getting Health Insurance Quotes
• Your Guide To The Best And Most Affordable Health Insurance Plans
• Best Small Business Insurance 2023

Get Forbes Advisor’s ratings of the best insurance companies and helpful information on how to find the best travel, auto, home, health, life, pet, and small business coverage for your needs.

Les is an insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Besides covering insurance, Les was a news editor and reporter for Patch and Community Newspaper Company and also covered health care, mortgages, credit cards and personal loans for multiple websites.

NEWS & RESEARCH REPORTS

It’s here open enrollment for 2024 insurance in pennsylvania is now available.

Open Enrollment for Pennsylvania’s health insurance marketplace, Pennie, begins in just a few days on Nov. 1. All insurers currently offering individual marketplace coverage in Pennsylvania’s 67 counties will continue to provide plans in 2024 with a statewide average increase of 3.9%, which is lower than what insurers initially filed. For 2024 health plans, Highmark is expanding into five new counties (Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) and Geisinger will expand its individual and small group offerings into Bedford County, increasing choice for consumers. In addition, consumers in Bucks, Philadelphia, and Montgomery counties will see one more health insurer offering coverage in the individual market as Pennsylvania welcomes another new entrant, Jefferson Health Plans, to the southeastern market. Consumers enrolling by December 15 can get coverage starting January 1, 2024, although Open Enrollment does not end until January 19, 2024

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Exploring coverage options for small businesses

Health insurance for businesses, group health insurance coverage.

• Learn more about purchasing insurance through SHOP
• See SHOP plans and prices
• How the Affordable Care Act (ACA) affects small businesses

Health reimbursement arrangements

• Qualified small employers
• Individual coverage, such as Marketplace plans
• Additional health benefits (when offered with a traditional group plan)

Health Savings Accounts and other tax-favored health plans

A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. HSA funds generally may not be used to pay premiums.

Refer to glossary for more details.

Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. The employer funds and owns the arrangement. Health Reimbursement Arrangements are sometimes called Health Reimbursement Accounts.

Health insurance support for small business

We’re here for you — helping you balance quality and cost control with health insurance plans and unique funding created exclusively for small group needs.

Plan support and savings

Digital enrollment tools.

Help your clients manage enrollment and benefits administration with our flexible tools.

• Springboard Marketplace

Health plan savings

Learn about government credits to help you offset the cost of employee health benefits.

Self-insured funding built for small businesses

Control rising health care costs with Aetna Funding Advantage SM  health plans. You can get the benefits typical for larger groups like surplus sharing, fewer taxes and fees and high-cost claims protection. All in one offering specially designed with your small business in mind.

A monthly payment based on the health trends of your employees — for up to 25 percent savings up front.

Online benefits shopping, enrollment, administration and other simple features for you and your employees.

Stop-loss insurance to limit the risk of high-cost claims, with money back when claims are lower.

Plan designs that provide access to Aetna’s quality, value-based network plus health and wellness benefits.

• Explore Aetna Funding Advantage benefits

A value-added package

You’ve come to the right place to balance health plan costs and quality. Explore competitive benefits, unique funding and stable cost control – with built-in wellness programs and resources to support employee health and well-being long term.

Get lower monthly payments based on health trends, low-cost local network options and 50% of any surplus returned to you at year end when you renew your plan.

Keep your costs predictable and stable with bundled products, funding options, wellness offerings, stop-loss claims protection and more.

Make life easy with a national portfolio of health insurance plan designs, online shopping and benefits administration and one common support model.

Get the job done fast with quick, accurate quoting, auto-case installation, online self-service, fixed national plan designs and more.

We’ve got the perfect fully insured plan for you

Our health benefits and insurance plans are as unique as your small business, with service in markets all across the country. So it’s easy to find quality plans offered in your state.

Public exchange options are also available in selected states through our Small Business Health Options Program (SHOP) coverage .

Everyone saves with health expense funds

As part of a consumer-directed plan, health expense funds benefit employers and employees alike. You get tax savings from salary deductions. And employees get quality care that encourages smart spending.

You can also:

• Cut FICA, unemployment and workers’ comp taxes by lowering payroll taxes
• Offer innovative plans to set aside tax-free money, like for dependent care or parking expenses
• Enhance company benefits package to attract and keep valuable employees

Are you a broker or producer?

You can find small group solutions and sales tools on our Producer World ® website.

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Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.    

See all legal notices

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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?  

Applied Behavior Analysis Medical Necessity Guide

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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.

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This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.

Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.

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• The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.
• Applies to: Aetna Choice ® POS, Aetna Choice POS II, Aetna Medicare ℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund ® products, Aetna Health Network Only ℠ , Aetna Health Network Option ℠ , Aetna Open Access ® Elect Choice ® , Aetna Open Access HMO, Aetna Open Access Managed Choice ® , Open Access Aetna Select ℠ , Elect Choice, HMO, Managed Choice POS, Open Choice ® , Quality Point-of-Service ® (QPOS ® ), and Aetna Select ℠ benefits plans and all products that may include the Aexcel ® , Choose and Save ℠ , Aetna Performance Network or Savings Plus networks. Not all plans are offered in all service areas.
• All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search."
• The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT ® ), copyright 2022 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
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• CPT only Copyright 2022 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

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This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

Dental clinical policy bulletins

• Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.
• While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.
• Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.
• Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
• Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.

Medical clinical policy bulletins

• Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
• While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
• Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
• CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
• Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
• In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 

See CMS's Medicare Coverage Center

• Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
• Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
• While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

See Aetna's External Review Program

• The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
• The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

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FOR 20% OFF CVS HEALTH BRAND PRODUCTS:

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Healthcare.gov

For a complete list of participating walk-in clinics, use our provider lookup. Walk in appointments are based on availability and not guaranteed. Online scheduling is recommended. Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high deductible health plans must meet their deductible before receiving covered non preventative MinuteClinic services at no cost share. However, such services are covered at negotiated contract rates. This benefit is not available in all states.

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If you’re self-employed and have no employees, take a look at individual plans underwritten by Golden Rule Insurance Company, a UnitedHealthcare company. Options include short term plans 1  that offer coverage for 1 to nearly 12 months in some states, 2  TriTerm Medical health insurance that offers coverage lasting nearly 3 years 3  and more.

Looking for Health Insurance Marketplace coverage from UnitedHealthcare?

UnitedHealthcare Exchange plans offer a variety of affordable, reliable coverage options. You can find plans available in your area at UnitedHealthcare Exchange plans or you can call 1-800-806-0451 TTY 711.

If you’re looking for ACA plans in New York or Massachusetts, visit Healthcare.gov or call 1-844-joinUHC to learn about plans available near you.

Save money on your self-employed benefits

The Affordable Care Act now allows a self-employed health insurance deduction on premiums of 100%, meaning that you can reduce your adjusted gross income by the total amount of health insurance premiums you pay in a calendar year.

Health insurance for small business

If you are self-employed but have employees working for you, whether it is a small staff or team of up to 99, you are considered a small business. Choose from a great set of options, made to work for your small business.

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Pennsylvania residents can now apply for Pennie

By Michael Guise

November 1, 2023 / 8:27 PM EDT / CBS Pittsburgh

PITTSBURGH (KDKA) — Residents in Pennsylvania can now apply for Pennie, the state's official health insurance marketplace.

Residents can apply, compare plans and enroll in coverage online. Enrollment runs from Nov. 1 through Jan. 15, 2024.

"Any Pennsylvanian who needs coverage should enroll now during Pennie's Open Enrollment Period. Waiting until you get sick or injured will mean it is too late to enroll," Pennie's Executive Director Devon Trolley said in a release on Thursday. "If you don't have coverage through your job or if you recently lost Medicaid, Pennie has affordable and high-quality health plans from the top insurance companies across the Commonwealth. We want all Pennsylvanians to have the protection and peace of mind that comes with having health coverage."   

In a social media post on Wednesday, Lt. Gov. Austin Davis encouraged residents to shop for coverage.

"Pennsylvanians that have experienced a major life event recently – like early retirement, getting married, or having a baby – may qualify to shop for coverage and apply for financial savings with @PennieOfficial," he posted to X , formerly known as Twitter. "Open enrollment begins today!"

Anyone who applies before Dec. 15 can receive coverage starting New Year's Day, Pennie said. 

For more information and to apply, click here . Anyone with questions can call customer service at 1-844-844-8040. Customer service is open from 8 a.m. to 7 p.m. Monday through Friday and on Saturdays from 8 a.m. to 1 p.m. during the open enrollment period. 

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Best small business health insurance.

A small business owner easily might become overwhelmed when it comes time to buy health insurance. With so many types of small business health insurance from which to choose, and so many companies offering those benefits, where is one to begin selecting health insurance ? After all, there are a lot of health insurance acronyms to understand.

Fortunately, the decision to purchase health insurance doesn’t have to be a daunting one. With just a little bit of knowledge and some basic information about small business health insurance companies, small business owners can make the best decisions for their companies and their employees

Types of Small Business Health Insurance

Before small business owners can understand the different health insurance options and various health insurance premiums, they must first understand the different types of small business health insurance plans. There are a few types of small business health insurance, each with its own benefits, deductibles and costs.

• HMO Plans – Health management organization (HMO) plans are limited health insurance plans with the goal of cutting healthcare costs. HMO plans work great for healthy individuals who are on a tighter budget and who are comfortable only visiting doctors within a prescribed network of healthcare providers.
• PPO Plans – Under preferred provider organizations (PPOs), patients have access to a larger network of doctors and more flexible care options, but they also typically pay higher costs for premiums and care. PPO plans are great for those who want to shop around for doctors, who are comfortable with and able to spend more, and who might need specialized care for a medical condition.
• POS Plans – A point of service (POS) plan combines the benefits of an HMO and a PPO. While customers still need a specialist’s referral from a primary care physician, they pay less for out-of-network medical visits. The cost of a POS generally falls somewhere in between an HMO and a PPO.
• EPO Plans – When consumers rely on an exclusive provider organization (EPO) plan for health insurance, they are encouraged to remain within their healthcare provider network, but they don’t need to get a referral if they choose to venture beyond it. The cost-effective health insurance option offers extra flexibility to small businesses.
• HDHP – A high deductible health plan can be a risk for those that are uncomfortable paying out of pocket for medical care. The high deductible means the plan won’t start paying toward healthcare costs until the patient has incurred at least $1,300 in expenses. These plans can be offset by establishing health savings accounts through the federal government. HSA for small businesses is a tax-advantaged account that can be contributed to by both employers and employees in conjunction with an HDHP.

Choosing the Best Small Business Health Insurance Plans

While understanding the different types of group health insurance plans will help small business owners when selecting health insurance, choosing health insurance coverage still remains a challenge for many small business owners. What do various health insurance plans have to offer, which is the best health insurance company, and how much does small business health insurance cost from various sources? Some health insurance providers might even offer additional options like self-employed health insurance , health savings accounts, benefits of dental insurance , and vision insurance coverage.

Navigating Health Insurance for Small Businesses: A Clear Guide to Choosing the Best Provider

As small business owners, we know that finding the right health insurance is more than a corporate necessity—it’s a vital component of employee well-being and business success. With an array of options clouding the decision-making process, we cut through the fog to bring clarity on what truly matters. In this section, we lay out the essential criteria to weigh when selecting the best small business health insurance plan. Our methodology is tailored to the unique needs of small businesses, ensuring that your choice not only meets legal requirements but also fosters a healthy, productive workplace. Here’s how we break it down:

Small Business Deals

• Scale of Importance: 9/10
• Plans must provide comprehensive coverage that meets your employees’ health needs without imposing restrictive limits.
• Scale of Importance: 8/10
• The plan should offer a fair balance between cost and the benefits received, ensuring it’s a sound investment.
• Scale of Importance: 7/10
• A wide network of healthcare providers ensures your employees have access to numerous quality care options.
• The ability to tailor plans to suit diverse employee needs can greatly enhance satisfaction and coverage effectiveness.
• Insurance should not be a maze; straightforward management and utilization are key for time-strapped small businesses.
• Scale of Importance: 6/10
• Access to responsive customer service can streamline the resolution of issues and provide necessary guidance.
• Feedback from current policyholders can give insights into the real-world application and satisfaction with the insurance.
• Scale of Importance: 5/10
• Programs that promote health and wellness can be invaluable, contributing to overall employee health and productivity.

Best Small Business Health Insurance Companies

What are the best health insurance providers for small businesses in 2022? Small business owners must consider a variety of factors when choosing the best health insurance company, including coverage, flexibility and cost. Most health insurance companies will offer similar plans, but each will feature unique elements and pricing. A small business owner might want to offer a health insurance option that includes dental insurance or even vision benefits, or they might seek the most affordable options or the best health insurance provider for overall general health coverage.

1. United Healthcare

Best For: Extensive coverage

Often chosen as the best health insurance for small business owners, United Healthcare features a large number of in-network providers and thousands of facilities throughout all 50 U.S. states. The health insurance provider makes substantial investments in technology to meet consumer demands, and it offers effective group coverage options for a variety of small businesses.

2. Blue Cross Blue Shield

Best For: Data-driven healthcare solutions

Other popular health insurance providers for small businesses include Blue Cross Blue Shield , which operates through the 36 local and independent health insurance companies in all U.S. states. Health benefits from Blue Cross Blue Shield are effective options for small business owners because the brand is trusted by millions of small businesses and their employees, and the health insurance plan is one of the nation’s most popular PPO networks.

Best For: Preventative care advantages

Providing health insurance as a small business can become a reality by choosing Humana as a small business health insurance provider. One of the largest insurance providers in America, Humana’s plans are known for their preventative care coverage and convenient plan features like wellness rewards. Humana makes it possible to offer health insurance by offering a variety of affordable plans for small business owners and their employees.

4. Kaiser Permanente

Best For: Affordability

Small business owners in eight U.S. states and the District of Columbia can choose an affordable small business health plan from Kaiser Permanente . The largest managed care organization in the country, Kaiser Permanente offers many affordable small business health insurance plans and options. With a strong emphasis on preventative care, Kaiser Permanente health insurance customers have the chance to stay healthy.

Best For: High deductible health plan options

One of the largest companies that provide health insurance in America, Aetna features competitive and affordable health insurance options for small business employers, including funding options and wellness offerings. In addition to offering health insurance, Aetna offers self-funded coverage to small businesses, and the health insurance provider is known for its high levels of customer satisfaction.

Best For: Flexible premiums and deductibles

While only available in 10 states, Cigna is still one of the best health insurance providers thanks to its broad range of small business health insurance options that accommodate a variety of needs, as well as its flexible premium and deductible options. Cigna features a large provider network, a detailed website and outstanding customer service.

Best For: Integrated health care

The largest for-profit managed health care company in the Blue Cross Blue Shield Association, Anthem is available to customers in 14 states. The health insurance provider has one of the most extensive networks in the country, so finding a doctor is a cinch. Because Anthem takes an integrated approach to medical care through combined health plans, patient data is connected to more effectively manage care.

What Health Insurance Companies Rank Best for Customer Satisfaction?

Both Forrester and Verint Systems have released studies ranking the nation’s top insurance payers based on customer satisfaction, with varying results. According to Forrester’s survey of more than 85,000 U.S. adults, Human ranks first for customer satisfaction, followed by Kaiser Permanente. Verint’s report , on the other hand, ranked United Healthcare first in customer satisfaction, with Humana coming in second place.

What Is The No. 1 Health Insurance Company in the United States?

With total revenue exceeding $286 billion in 2021, United Healthcare is the largest health insurance company in the United States by revenue, according to analysis by ValuePenguin. The insurer is also the largest company by membership and market share. Anthem is the second-largest health insurance provider in all three categories.

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What small business owners need to know about Medicare now

Baby Boomers own a lot of small businesses.

In fact, according to the US Census Bureau, over half of small business owners are over 55 years of age. That means that right now millions of them are being bombarded with ads and mail about Medicare plans because we are smack dab in the middle of the annual period to enroll in Medicare or change your plan between Oct.15 to Dec. 7.

So listen up: If you’re a small business owner, whether you’re approaching the age you can sign up for Medicare – 65 – or already on Medicare, now’s the time to think about your choice of Medicare plans and think carefully.

This choice can cost you or save you thousands, maybe tens of thousands, of dollars.

When does Medicare open enrollment take place? Here's what to know when picking your plan.

For context, it helps to understand that health insurance for small business owners – and their staff – is jaw-droppingly expensive. Before the Affordable Health Care Act was passed (Obamacare), small business owners over the ages of 50, even 40, were charged such high premiums that it was clear the insurance companies didn’t want us.

Personally, I went without health insurance until my mid-forties. Yes, I know it was stupid, but running a business was expensive. Once I hit 50, the premiums were always over a thousand dollars a month and then over $1,500 a month for lousy coverage.

The ACA changed that. Somewhat. Now, a 55-year-old in California making $50,000 a year can get a “Silver” plan for only $321 a month, and someone making $150,000 a year would pay only $856 for that plan.

If you think the word “only” shouldn’t apply for a monthly premium that high, believe me many older small business owners consider that a bargain.

That’s why many small business owners are thrilled when they qualify for Medicare. It’s about the only benefit of getting older. But it’s a big one.

Yet it can also be confusing. There’s all kinds of terms that sound the same – Medicare, Medigap, Medicare Advantage, Supplemental plans, and on and on.

Let’s start with the basics.

Going solo?  Here's why private Medicare plans are set to pass traditional Medicare enrollment

The government program that provides coverage for basic health care. There are different parts to this Original Medicare:

• Part A covers the really expensive stuff: hospitals, skilled nursing, surgery
• Part B covers preventative care, doctor visits, lab tests and so on.
• Part D covers prescription costs.

But Medicare doesn’t cover all the costs – you’ll still pay around 20% of your health care costs, which can be substantial. You’ll also pay the government a premium for Part B. You can choose whether to buy Part D for additional cost.

Medigap or Supplement Insurance 

Original Medicare still leaves significant costs and gaps in your coverage, so you can purchase a supplemental plan to lower your out-of-pocket expenses.

There are a number of different plans to choose from, some that cover virtually all of your expenses. Of course, the cost of your premiums increase as your coverage increases. There’s a good chart on the government’s website that compares the features of the different Supplement plans.

Republicans won't touch your Medicare benefits. But insolvency looms without changes.

What is a Medicare Advantage 

Offered by private insurance companies, Medicare Advantage plans wrap basic Medicare benefits into one package. They have much lower premiums than Medigap/Supplement plans – some actually have no monthly premiums at all. But you are likely to have co-pays and a yearly deductible.

However, many of these plans offer a number of benefits not included in Supplement offerings, including dental and vision coverage, even gym membership.

What’s the big difference between Medigap and Medicare Advantage?

Advantage plans are cheaper than Medigap/Supplement plans – often a lot cheaper or even ‘free.’ But, of course, there’s a catch – and it’s a big one!

With a Medigap/Supplement plan, you can go to any doctor or hospital that accepts Medicare – anywhere in the US. And you don’t need a doctors’ referral to go to a specialist.

You want to go see a dermatologist or a podiatrist? Just make an appointment; no need to get the approval of your primary physician. And if you want to see a specialist in another state, you can. With some plans – including the most popular Plans F and G – you’ll have virtually no out-of-pocket co-pays or deductibles.

That’s not the case with Advantage programs. They act as HMO’s (Health Maintenance Organizations) or PPO’s (Preferred Provider Organizations). You must go to a doctor or hospital that is in your insurers’ specific “network,” and you must get a referral before going to a specialist.

Any services out-of-network or out of your local area are likely not to be covered. If you move, you may not be covered. You’ll have co-pays and out-of-pocket expenses for most services. Those costs can be huge.

Here's the most important thing to remember: The first year you qualify for Medicare, you can choose any plan you want without health considerations affecting your acceptance or pricing. Insurers can’t reject you because of pre-existing conditions.

Even better, you can keep that plan as long as you keep paying for it. If you choose a less expensive Advantage plan now, you can be rejected from a more comprehensive Supplement plan in the future.

Choosing a Medicare plan? Here are 7 things to consider

For example, let’s say Sam, who owns a graphic design firm, has just turned 65, and she’s signing up for Medicare. She’s had breast cancer. Thank goodness it’s in remission, but she wants to make sure she can see her own oncologist or go for treatment in another state if the cancer comes back.

She can afford the monthly premiums, so she chooses a Supplement plan – in her case, Plan “G,” that will cover all those costs. If she signs up now, when she’s first eligible, she can’t be rejected because of her cancer, and the insurance company can’t kick her off or raise her premiums in the future more than the standard amount set by the government.

However, another Sam, who owns a small car repair shop, has a few health issues and heart disease runs in his family. He’s struggled to pay for health care. He’s thrilled to sign up for an Advantage plan that has no monthly premiums. He also gets dental and vision coverage, and now can join that gym and work out.

But he has to choose a doctor in network, and if his doctor or hospital drops off his plan, he’ll have to find another doctor. More importantly, if he has heart problems in the future, he may face some high hospital bills, won’t be able to go to a specialist that is out-of-network, and is likely not to be able to switch to a more comprehensive Medigap/supplement plan.

How do patient assistance programs work? The pros and cons of prescription coupons and more.

Here’s the other thing to keep in mind: Insurance brokers get paid more for signing you up for an advantage plan than for a Medigap/Supplement plan.

For 2022, for example, an agent could get up a commission up to $573 for a first-time Advantage enrollment (higher in some states, such as $715 in California) while the average commission for enrolling someone in a Supplement plan was $322. So when an insurance broker is urging you to sign up for an Advantage plan, keep in mind they’re going to make more money if you do .

What do I recommend?

• The year you qualify for Medicare, sign up for the best plan you can afford. Insurers can’t reject you because of pre-existing conditions.
• If you can afford one of the best and most popular Medigap/Supplement plans – Plan G or Plan F (Plan F is only available if you qualified for Medicare before 2020) – you’ll have the best coverage.
• If monthly health care premiums are your biggest concern, choose an Advantage plan. Just be aware of the limitations.
• Sign up for something! It’s better to have any plan rather than no plan.
• If you have a pre-existing condition or any condition that might require specialists or out-of-area doctors or hospitals, seriously consider a Supplement plan.

Don’t wait to sign up. Even if you can get health insurance from a spouse’s employer, sign up. Your costs may go up if you wait.

Also, some Republican legislators have expressed an intent to reduce Medicare benefits. If they control Congress and the White House after the 2024 election, I’d expect the age to sign up for Medicare to be increased, possibly to age 70. Those already on Medicare would likely be ‘grandfathered’ in.

I know it’s all a bit confusing, but Medicare is a great boon to small business owners who face some of the highest prices for health insurance. Don’t wait.

Correction: The original publication of this column misstated the proportion of health care costs not covered by Medicare. The correct figure is around 20%.

Journalism that gets results for Pennsylvania

Independent

Nonpartisan

Bad tech, staffing shortages hinder Pa. as it reassesses health care coverage for 1000s

By katie meyer of spotlight pa | oct. 23, 2023.

Spotlight PA is an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania. Sign up for our free newsletters .

HARRISBURG — Pennsylvania is struggling with faulty technology, persistent staffing shortages, and flawed procedures as it reassesses health care coverage for hundreds of thousands of adults and children.

All states were required to begin reevaluating who qualifies for Medicaid and the Children's Health Insurance Program, or CHIP, in April as part of the “unwinding” of pandemic-era rules that allowed for continuous coverage.

Since then, tens of thousands of people in Pennsylvania are believed to have wrongly lost their benefits, at least temporarily.

Determining the exact impact is difficult. For instance, the Shapiro administration doesn’t know how many people lost benefits because of paperwork issues but were actually eligible.

Broadly, it’s clear that Pennsylvanians are dealing with a frustrating bureaucratic maze when they try to reenroll or correct coverage errors through the commonwealth’s Department of Human Services.

Kathryn Ah Wong is one of those people.

In April, the Crawford County mother of two was told her younger son had been kicked off of his CHIP benefits because he had outside insurance. It was an error, Ah Wong said, but it led her on a monthslong odyssey.

It’s possible Ah Wong’s issues were related to yet another big change Pennsylvania was undertaking earlier this year: an ambitious IT overhaul of its CHIP system , switching the responsibility for reenrolling children in that program from participating insurers to DHS.

That move transferred new responsibilities to county caseworkers, who were already dealing with heavy workloads because of the record number of people enrolled in Medicaid.

This isn’t the only issue Ah Wong has faced since the unwinding began. All the while, she said workers have been “pretty blatant” in telling her that they didn’t know how to help her.

“[They were] just explaining, ‘I got a four-minute training. This all got thrown on us. I [also] have to do SNAP benefits,’” Ah Wong said. “Every person I've talked to has been super apologetic, which is great, and just forthcoming with the fact that they don't know what they're doing.”

Ex parte problems

Under non-pandemic conditions, Medicaid and CHIP recipients have to reenroll in their benefits every year. Now that this process has restarted, there are a couple of ways it’s happening .

People on benefits should begin receiving notices in the mail about 90 days before their appointed reenrollment date; they’ll also get emails and texts if DHS has contact information on file. They can either mail back the necessary forms, submit them online, or they can visit a county assistance office for in-person help.

In a small minority of cases, the state can conduct what’s known as an ex parte renewal, in which county workers use publicly available information to automatically reenroll a person.

The federal government has been pushing states to use this method, which is considered to be more efficient for administrators and easier for benefit recipients, who end up with a lower chance of losing coverage over bungled paperwork.

But Pennsylvania has among the lowest rates of ex parte renewals for Medicaid in the nation. Since the unwinding began, just 4% of Medicaid renewals have been done through the ex parte process, higher than only Texas and Wyoming .

In a conversation with Spotlight PA, top DHS officials, including Secretary Val Arkoosh, conceded that it’s something they’re working on.

Hoa Pham, a deputy DHS secretary who heads the Office of Income Maintenance, said “a number of really specific technical challenges” with the state's systems serve as a barrier to expanding ex parte. Plus, she said, DHS has policies that require certain "guideposts" for a case to be completely renewed using the ex parte process.

Officials said one of the big limitations is that the ex parte system was only designed for people who aren’t on multiple benefit programs — like SNAP along with Medicaid — and who don’t have significant assets that need to be accounted for. People with these more complicated cases are excluded from ex parte renewals.

“We really do want to see the rates of ex parte renewals increase over time,” Pham said. “We've got a number of plans over the next year to make some substantial progress in that regard.”

Officials added in a statement that there is a reason they aren’t moving more quickly to boost ex parte numbers.

“Accuracy has, and will continue to be, our primary goal for the 12-month unwinding process — which the federal government has made clear it supports,” a spokesperson for the department wrote in an email. “Rushing through processes could lead to wrongful terminations, as we've seen in other states.”

Patrick Keenan — policy director at the Pennsylvania Health Access Network, which advocates for people in the benefits system — said these problems aren’t new, and he’s optimistic that the current administration is trying to solve them.

The system, he said, “has underperformed for a very long time now.”

Another issue with Pennsylvania’s ex parte process was spotlighted in late August when federal officials sent letters to state Medicaid directors flagging that “multiple states” were conducting automatic reassessments in a way that “may be resulting in eligible individuals being improperly disenrolled.”

They asked states to assess the damage and in September, released data showing that Pennsylvania was among the states using a faulty process and was one of just two that may have wrongly disenrolled more than 100,000 people as a result.

The problem involved states conducting what are often called household-level reassessments.

Essentially, if one member of the household was suspected of being ineligible, Pennsylvania asked all members to fill out reenrollment paperwork. If any household member failed to return that paperwork, the state took away their health insurance.

If all members of a household had the same income limits, this approach was unlikely to cause harm. But in cases in which some members of the household had higher limits than others — for instance, if they were children on CHIP — then they could be kicked off the rolls inappropriately.

Arkoosh said the Centers for Medicare and Medicaid Services was aware Pennsylvania was using a household-based approach to reenrollements.

She also said Pennsylvania’s estimate of more than 100,000 people losing access to benefits is likely too high. The commonwealth is still figuring out exactly how many people were affected, but the initial figure it submitted to the feds was “the maximum, highest possible universe of households that could be impacted.”

Federal officials have instructed states to start automatically reenrolling people on the individual level, instead of as a full household. Pennsylvania isn’t equipped to do that, said Pham. Instead, with CMS’ support, caseworkers are now manually checking publicly available income data and other financial factors to assess eligibility.

This slower, lower-tech approach takes “more time,” Pham said. “While it's not our ideal that it's not automated, we are conducting the type of review needed to ensure that the folks who are eligible maintain eligibility.”

Pennsylvania has also lagged in figuring out exactly who was wrongfully terminated under the old ex parte system. Nevada, the other state with more than an estimated 100,000 people incorrectly disenrolled, told the New York Times last month it has already restored benefits to about 114,000 people.

At publication time, Pennsylvania DHS officials didn’t have a final number of people affected and hadn’t restored coverage to anyone.

Federal officials have given states a deadline of the end of November to accomplish the fix, DHS leaders said.

An overwhelmed system?

These tech issues are compounded by short-staffing in the offices that process benefit cases, advocates for health care access argue.

DHS is 91% staffed statewide, according to department leaders, who said that’s not bad overall. But big counties are struggling more, they said.

Allegheny County is 85% staffed, and Philadelphia is about 83% staffed. Certain categories of jobs have been especially hard to fill.

Joanna Rosenhein, a consumer engagement manager with PHAN, said Philadelphia’s office only has about 71% of the necessary clerical workers, whose responsibilities include digitizing important paper documents.

“Across the board, the department is not immune to staffing challenges that other private employers have been encountering,” Arkoosh, the DHS secretary, said. But, she argued, the department has dealt with the challenges well, by shifting workloads to counties with less staffing.

And overall, Arkoosh said, the state’s reenrollment numbers have been fine.

DHS only provided complete data for April and May , the first two months of the unwinding. In both of those months, about 71% of enrollees kept their coverage and a little less than 13% were found ineligible. Another 15 to 16% were terminated for “procedural” reasons, which means it’s unclear if they were eligible, but missing paperwork precluded their renewal.

Advocates maintain that they see other signs that the system is bogged down.

In its August report to the federal government, for instance, Pennsylvania reported that of the roughly 322,000 people due for renewal that reporting period, more than 40% didn’t have their renewals done when the period ended.

That large volume of pending renewals could show that people are waiting for their applications to be processed. The Center on Budget and Policy Priorities, which closely monitors Medicaid unwinding, notes that while enrollees keep their coverage for the duration of their reenrollment no matter how long it takes, long wait times can confuse people.

They "may not realize that they’re still covered," CBPP wrote in its Unwinding Watch . People "may forgo care or have to make multiple phone calls to determine their status."

Keenan, the PHAN policy director, said it’s a problem. “Timely and accurate eligibility decisions help new applicants get the medical care they need,” he said.

Arkoosh argued that this is an uncharitable interpretation of these numbers.

While reenrollments are only supposed to last 30 days and the department often takes longer than that, it’s for the good of Medicaid users, Arkoosh said.

“That's really what we're always focused on, is keeping people covered,” she said.

Advocates from PHAN and Community Legal Services of Philadelphia, which also helps people navigate the benefits system, said that anecdotally, they’ve seen a notable rise in people who are reporting interminable wait times — another sign, they say, that points to an overloaded system.

“They wait on hold for hours just to talk to anybody,” said Maripat Pileggi, a supervising attorney at CLS Philly. “It can be very difficult.”

PHAN’s Rosenhein said that she thinks the CHIP IT transition is also playing a role in slowing things down.

The CHIP enrollment process includes verifying that a child doesn’t have outside health insurance. PHAN, Rosenhein said, has “seen delays in this verification process throughout the unwinding period, leaving some children who are transitioning from [Medicaid] to CHIP without coverage for over a month.”

Many of these factors have been in play for Bethany, a 27-year-old mom of two who lives outside Allegheny County and whose children, as of mid-October, had no medical coverage. Bethany preferred not to use her last name while publicly discussing her benefits.

She said over the summer, she played hours of “phone tag” with DHS to resolve Medicaid issues after she returned to work following the birth of her younger daughter.

A new issue popped up this month. After she switched jobs and filed new pay stubs to keep her daughters’ benefits, she got two separate, conflicting notices from DHS. One said she hadn’t submitted the information she said she had, and the other, scarier one said nobody in her family qualified for either Medicaid or CHIP.

At least part of the error was likely due to “staffing issues,” according to Keenan, who learned about Bethany’s case after she turned to PHAN for help.

Keenan said the children qualify for CHIP and is hopeful the issue will be resolved quickly. But in the meantime, Bethany is in a tough spot. It’s too expensive to add her daughters to her work insurance — “we're talking a $5,000 deductible,” she said — and for now, her daughters are uninsured.

“What really stresses me out is like, kids get sick,” she said. “It's October. It's flu season. COVID exists. My kids get sick, I have to wonder, can I take them to the doctor?”

Ah Wong, the Crawford County mom who spent the spring and summer trying to get her younger son back on CHIP, is in a similar situation.

After months spent battling with DHS, she said the initial issue was resolved. But when it came time to reenroll both of her boys in the program in August, she said she got a notice, without warning, that their coverage had been terminated.

She filed an appeal and was told she was missing income information. She resubmitted the information and said she was told everything should be resolved. But this month, when she tried to schedule doctor’s appointments for her sons, she was once again told they didn’t have coverage.

Last week, one of her sons spiked a fever. When she spoke to Spotlight PA, she was trying to figure out if his coverage had been restored so she could take him to the doctor. It was unclear.

“I feel like I'm a fairly competent person. I have appointments scheduled, I keep up with things, my bills are paid,” she said. “And I have spent hours and hours and hours having to follow up with people and try to do their job and try to problem solve on my own. Because of just complete and total incompetence.”

“There's not even a person to call,” she added. “I don't know what to do.”

BEFORE YOU GO… If you learned something from this article, pay it forward and contribute to Spotlight PA at spotlightpa.org/donate . Spotlight PA is funded by foundations and readers like you who are committed to accountability journalism that gets results.

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