Most small business owners know that unless they have 50 or more full-time exempt employees (FTEs) they’re not required to offer health coverage. However, if you’re a new business owner or are just now looking to offer your employees insurance options, this may be unfamiliar territory.

While not every business with less than 50 employees chooses to invest in health insurance, according to one survey, over half or 56 percent of smaller employers currently offer health insurance to employees.

And the benefits of doing so are numerous and substantial.


The Impact Of The Affordable Care Act On Small Business Health Insurance a doctor holding a chalkboard that says "affordable care act"

The Affordable Care Act (ACA), also known as Obamacare, was enacted in 2010 with the aim of expanding access to affordable health insurance coverage in the United States.

While the ACA primarily focuses on individual insurance markets, it has also had notable implications for small businesses and their health insurance offerings. In this article we will provide a brief overview of the impact of the ACA on small business health insurance and highlight some key changes.


Increased Options And Marketplaces

  • The ACA established Health Insurance Marketplaces, where individuals and small businesses can compare and purchase health insurance plans.
  • Small businesses can access the Small Business Health Options Program (SHOP) to offer health insurance coverage to their employees.
  • These marketplaces and programs provide increased choices and transparency for small businesses, empowering them to find affordable coverage that suits their needs.

This means that small business owners who may have struggled to navigate the complex insurance market can instead use the SHOP marketplace to explore various plans and make an informed decision for their employees.


Employer Mandate and Shared Responsibility

The ACA employer mandate is a provision that requires large employers to offer affordable and comprehensive health insurance to their full-time employees and their dependents or pay a penalty to the IRS. Full-time employees are those who work at least 30 hours a week and large employers are those who have 50 or more full-time employees or full-time equivalents. The employer mandate is also known as the employer shared responsibility provision or the “pay or play rules”.

  • Under the ACA, businesses with 50 or more full-time employees are required to offer health insurance coverage or face penalties.
  • The employer mandate aims to ensure that large employers contribute to their employees’ healthcare costs and reduce the burden on public insurance programs.
  • Small businesses with fewer than 50 full-time employees, however, are exempt from the mandate but can still choose to offer coverage through the SHOP marketplace.

Example: A small business with 48 employees is not mandated to provide health insurance, but it may still opt to do so to attract and retain talented employees, leveraging the benefits offered through the ACA.


Tax Credits And Cost Assistance

  • The ACA provides tax credits and cost assistance to eligible small businesses that offer health insurance coverage to their employees through SHOP.
  • Small businesses with fewer than 25 full-time equivalent employees and average wages below a certain threshold may qualify for tax credits.
  • These incentives help alleviate the financial burden of providing health insurance for small businesses, making coverage more affordable.

A small business with 15 employees, for example, with average wages below the threshold can take advantage of tax credits to significantly reduce the cost of providing health insurance, enabling them to offer better benefits to their workforce.

So, how does this work?

Businesses that have fewer than 25 full-time equivalent employees, pay average annual wages below $50,000, and contribute 50 percent or more toward employees’ self-only health insurance premiums may qualify for a small business tax credit of up to 35 percent to help offset the costs of insurance.

The maximum credit is 50 percent of premiums paid for small business employers, and 35 percent of premiums paid for small tax-exempt employers. The credit is available to eligible employers for two consecutive taxable years. The amount of the tax credit you receive is based on a sliding scale. Simply put, the smaller the employer, the bigger the credit.


Essential Health Benefits and Pre-existing Conditions a paper, a pen, and a clipboard with a piece of paper that says "pre-existing condition"

  • The ACA mandates that health insurance plans, including those offered by small businesses, cover essential health benefits such as preventive services, prescription drugs, and mental health treatment.
  • The law prohibits insurers from denying coverage or charging higher premiums based on pre-existing conditions.
  • These provisions ensure that employees of small businesses have access to comprehensive coverage and protection from discrimination based on their health status.

What this means for your business is that, because of the ACA’s protections, an employee with a pre-existing condition, previously denied coverage or charged exorbitant premiums, can now access quality healthcare through your company’s health insurance plan.

[h3]  Administrative Simplification

  • The ACA introduced standardized health insurance forms and requirements, reducing administrative complexity and paperwork burdens for small businesses.
  • Small businesses can now focus more on their core operations rather than grappling with intricate insurance processes.

In other words, a small business owner no longer needs to spend significant time deciphering complex insurance paperwork, allowing them to devote more attention to running their business effectively.


Small Businesses Have Benefited From The Provisions Of The Aca

It is true that the Affordable Care Act has had a significant impact on small business health insurance by offering increased options, tax credits, essential benefits, and administrative simplification.

And although the employer mandate only applies to larger businesses, smaller enterprises can also benefit from the ACA through the SHOP marketplace. By expanding access, reducing costs, and ensuring essential coverage, the ACA has played a vital role in improving the availability and affordability of health insurance for small businesses and their employees.


Need Help Finding Health Insurance Coverage For Your Business?

J.C. Lewis Insurance has been a local, family-owned firm based in Sonoma County since 1979, and our team of expert brokers offers small business and individual health insurance plans from only the leading health insurance carriers that are licensed to do business in California.

In addition to being experienced, professional brokers, we are licensed and certified by each of these insurance carriers to offer coverage to individuals, families, and small group employers in addition to Medicare supplemental and prescription drug plans for seniors.

When you’re shopping for vision, dental, or health insurance for your employees you will likely have several questions and concerns.

At J.C. Lewis Insurance Services we welcome your questions about insurance coverage and you can be confident that we will help you find the right solution.