Under 50 employees, you're not required to offer anything. That makes this a business decision rather than a compliance one — which is harder, not easier.
If you have fewer than 50 full-time equivalent employees, the ACA employer mandate doesn't apply to you. No penalty for offering nothing. Which means you're deciding whether coverage is worth it, not whether it's required.
Most owners I talk to are weighing the same thing: they want to keep good people, and they don't want to commit to a cost that grows faster than revenue.
Most owners come to this question thinking about the team. Worth starting somewhere else: you're usually the highest earner in the business, which means you're the one most likely to be above the subsidy cliff and paying full retail for your own family's coverage.
For 2026, premium tax credits end above $62,600 for an individual and $128,600 for a household of four. If your household clears that — and if you're profitable enough to be considering employee benefits, it probably does — the Marketplace is quoting you unsubsidized rates. For a healthy family that's frequently the most expensive option on the table, not the cheapest.
A non-Marketplace PPO often costs meaningfully less per month with a broader network. Sorting out your own coverage first is also just practical: it's usually the largest single premium in the picture, and it clarifies what you can actually afford to contribute for everyone else.
A word on what these plans are, because vague descriptions are how people get surprised. They're medically underwritten — the application asks about your health history, and coverage can be declined, limited, or priced based on it. They're also not ACA-compliant, which means pre-existing conditions may be excluded and the essential health benefits guaranteed on every Marketplace plan aren't automatic here.
What you get for that is a lower premium, a real maximum out-of-pocket, and frequently a wider network. Whether that trade favors you depends almost entirely on your health, which is why it's the first thing I ask about — before I quote anything. Term length and renewal rules vary by plan and by state, and I'll tell you exactly what applies to yours.
If you have an ongoing condition, an ACA plan's guaranteed coverage is often worth more than the premium difference, and I'll say so. That's a real conversation, not a formality.
You choose one plan, or a small menu, and pay a defined share of the premium. It's the most familiar option and the easiest to explain to employees. It's also the least flexible: renewals are annual, increases are yours to absorb or pass along, and participation requirements mean you often need a minimum share of eligible employees to enroll.
Group coverage is genuinely good when your team is stable and you want a benefit that feels like a real benefit.
An individual coverage health reimbursement arrangement flips the model. Employees buy their own individual plans, and you reimburse them a fixed, tax-advantaged amount. You control the number rather than absorbing a renewal.
The tradeoffs are real. Employees who take an ICHRA reimbursement generally can't also claim a Marketplace premium tax credit, which means for lower-paid employees an ICHRA can leave them worse off than if you offered nothing at all. It also pushes plan selection onto people who may not want it. ICHRAs work well for some businesses and poorly for others, and the difference usually comes down to your team's income mix.
Sometimes this is the right answer, and I'll say so. If your employees qualify for substantial Marketplace subsidies, a modest group contribution can leave them worse off by disqualifying them from credits worth more than your contribution. Raising wages and letting people use the Marketplace is occasionally the better deal for everyone.
That's not the advice a broker earns the most from. It's sometimes the correct advice, which is why it's on this page.
Look at your team's size, income mix, and turnover, then price all three paths against each other with real numbers. If group coverage wins, I'll set it up. If an ICHRA wins, I'll explain exactly who it helps and who it hurts. If the honest answer is that a raise beats a benefit, you'll hear that too.
Nothing. Not a fee, not a markup, not a "consultation charge." Brokers are paid a commission by the insurance carrier, and that commission is built into the premium whether you use a broker or not. Enroll directly and the carrier keeps it. Enroll through me and it pays for someone who works on your behalf and picks up the phone in March when something goes wrong.
The plan costs the same either way. I'd rather you know exactly how I'm paid than wonder. There's a fuller explanation on the licensing page, along with my NPN so you can verify I am who I say I am.
Employers with fewer than 50 full-time equivalent employees are not subject to the ACA employer mandate and face no penalty for not offering coverage. Employers at or above 50 FTEs are subject to it.
An individual coverage HRA lets an employer reimburse employees a fixed, tax-advantaged amount toward individual health plans they buy themselves. It gives the employer cost control, but employees who accept the reimbursement generally cannot also claim Marketplace premium tax credits — which can leave lower-paid employees worse off. Whether it beats a group plan depends heavily on your team's income mix.
It can. If employees qualify for substantial Marketplace premium tax credits, an offer of affordable employer coverage can disqualify them from those credits. In some cases a modest employer contribution leaves employees paying more than they would have on a subsidized Marketplace plan. This is worth modeling before committing.
Licensed in 29 states as Rohr Health Advisors LLC — Cavin Rohr, NPN 21388659. You can verify that before you call me, and I'd encourage it.
No fee, no pressure, no obligation to enroll in anything.
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