Small Businesses Can't Get Straight Answers on ICHRA Plans
Small and mid-sized businesses are facing increasing challenges with employee health benefits, including rising costs, complex regulations, and limited coverage options. These businesses are grappling with PEO changes, high claims, and the difficult decision between fully insured plans, self-funding, and navigating international insurance complexities. The unpredictable nature of healthcare costs and provider rates creates significant financial and administrative burdens.
SOURCES (60)
“I work in a family owned outpatient private practice clinic. Pay is above average, but our benefits are not good. - 10 days PTO (20 after 5 years) - high premium health insurance. - no designated CEU The one that KILLS me is no 401k.…”
“Open enrollment season got this going. small businesses spend a lot on health insurance, but it seems like most candidates only look at the salary number. Would a solid benefits package make you take a lower paying job? or is it pretty much salary first and everything else second? submitted by /u/helpside_Team [link] [comments]”
“Your contract agency who places you makes about as much as you do. Also health insurance with a contract agency is typically much worse than a full time employee”
“Curious how others handle this. CalSavers, OregonSaves, Virginia dropping to 5 employees. How do you keep track of which clients are affected, especially ones not on Gusto or ADP? Spreadsheet? Payroll software? Not your responsibility? submitted by /u/Peter_Orage_Roberts [link] [comments]”
Her new job only offers her a plan at a 50% reimbursement for just her
“I’d ask them to put the comparison in writing using your current employee census and coverage levels, including not just the health premiums but PEO/admin fees, workers comp if applicable, payroll fees, implementation costs, minimum fees, and anything else that changes by joining them. I’d also ask what happens at renewal. Saving a lot in year one doesn’t mean much if the rates jump significantly in year two. A few other things I’d want answered: Is the health plan fully insured or self-funded?”
“My employer is moving us to 1099 No more health insurance No more 401k matches No more benefits really at all I just started a year ago and all this is changing. And the kicker is my employer has told us this is all happening. But has yet to tell us how much we are even getting paid and how. He says, hey you can write more stuff off so you will benefit from that. But that’s all. I’m in NY if that matters. But it’s BS but it’s a tricky situation. submitted by /u/Efficient_Wealth_495 [”
“Hi, as many of you are probably aware, the cost of health insurance has skyrocketed. I’ve been approached by brokers offering PEO plans for health insurance, and they’re claiming they could save us around $50,000 a year compared with our current plan. I haven’t sat through the proposal yet, but we have a meeting next week. Before I do, I’d love to hear from anyone who has made the switch from a traditional small business health plan to a PEO. What was your experience? Were the savings actually w”
“Have to purchase a marketplace plan for my family. Wife is losing coverage will only have a 50% towards her own plan after 3 months. Can the s corp reimburse me if I buy the plan through the NYS marketplace and I have it on my w2? I don’t want to trigger any non-discrimination issues as I have employees (can’t offer them a plan) can’t afford it. Was told it would go onto a box on w2 and then written off on personal return and not pay fica or Medicaid on it. I am lost on this being right or wrong”
“Yes, the penalty is prorated and it only applies for months when you don't have either an exemption or coverage. You do not have to file Form 3853 if you have coverage that will pay for any healthcare you need while you are in California. Are you filing your CA return as a full-year resident or part-year resident? It sounds like you're only a part-year resident and would only have to buy insurance while you're here if you don't already have coverage. If you filed Form 3853 in err”
“I have 19 w2 employees and my wife is losing her coverage we are all on now and taking a job where they only offer her a plan. Due to that I want to have my s corp pay for the plan for me and the kids. One issue I am worried about is triggering the $100 per day ACA penalty. Also my daughter works part time as a w2 employee at the business. I’d be seeking to do this via 2% s corp shareholder box 1 on my own w2. I read my daughter is considered a 2% shareholder through family attribution. I’m very”
“be careful about changing the business entity or choosing a payroll provider primarily because it looks cheaper health insurance. There are enough tax and rules involved that the advertised monthly price may not reflect what you can actualy use. Ignition benefits is an example of taking a benefits first approach rather than bundling everything into whichever payroll system is most convenient. Id compare the marketplace and ICHRA and any available small group routes side by side including premium”
“Currently discussing a job opportunity with a recruiter with NutraCo. I’m curious if anyone knows what their current health benefits look like in terms of premium/deductible/copays. I have T1D and two little ones on my insurance so having decent insurance is a must for me. TIA! submitted by /u/FantasticSign7472 [link] [comments]”
“At the end of each year, our WC provider sends us an "audit" and a request for a check to cover what the audit revealed. We're a small company of 8 full time employees. No claims have been filed. Every single year. submitted by /u/visgirl1956 [link] [comments]”
“I’m a W-2 worker and I have been working for this same job for 5 years now. The employer did not provide health insurance for the first 4 years so I negotiated for health insurance. Thing is, the ONLY plan they offer isn’t good and they would only cover half of the premium (~$350). Also, if I were to buy my own plan, they would not reimburse half of the premium, like they would with their provided plan. They would only reimburse up to the $350. Now they started reimbursing me for the plan I got”
“They don’t pass the ABC test in California based on what OP said. I think it’s a low risk especially if it’s short term and not a lot of pay, but it isn’t risk free and not a textbook case for a 1099. Most companies I know outright refuse to 1099 a prior employee in CA.”
“I have been working for this small hotel for about 3 years. Been getting benefits. Used to be a different company, then the owner of the hotel was dissatisfied with the company running the operations and switched. Well the new company has been extremely cheap. I was getting a gratuity and when the new company came in, they only applied gratuity under certain conditions. I was still making money but not as before. We had a nice breakfast buffet. The hotel was full. New company didn't like tha”
“Does anyone have experience with either? Looking to get health benefits for my employees and I think it’s down to these two options. I have a small gut feeling on which way to go, but it’s based on practically nothing so any input would help. submitted by /u/youremygrandma [link] [comments]”
“Has anyone had success accessing a group health plan outside of the ACA marketplace as a solo practice/business of one? My daughter has an out-of-network doctor she really needs to keep, but in NJ there's no out-of-network coverage available. This doctor is only in-network with Aetna, and Aetna has exited the individual market in NJ. I'm open to creative setup. I'm a 1099 physician. The irony is real here. submitted by /u/Phillophile [link] [comments]”
“Does anyone have experience with either? Looking to get health benefits for my employees and I think it’s down to these two options. I have a small gut feeling on which way to go, but it’s based on practically nothing so any input would help. submitted by /u/youremygrandma [link] [comments]”
“Large clinic in Cleveland announced that we can use our PTO to pay for our health premiums. That statement is so tone deaf to me. So, costs are rising, premiums are going up… but guess what guys? We’ll let you give up your hard earned PTO (that isn’t enough as it is!) to help pay for costs. No mention of more PTO, cost of living increases…. just higher premiums and the fact that they are now letting us have this amazing option!! Meanwhile, the people making these decisions would never have to gi”
“Hello, I accepted and started a new job. I asked about the health insurance before I started and was not given any indication that there would be an issue. Today during orientation, I learned that my health insurance has essentially no in-network providers where I live because I am a remote employee in another state. The plan does have out-of-network coverage, but my biggest concern is balance billing. The plan documents specifically state that out-of-network providers can bill me for the differ”
“Any recommendations? We have a very small business, but employees in 2 locations. One near Portland and one rural. submitted by /u/HistoryPristine1029 [link] [comments]”
“I’d start with a local health insurance broker cause they can help you compare plans and handle a lot of the setup, which makes things easier with such a small team. Another option is to give employees money each month to help cover their own insurance, you have a lot of companies that can help with this type of set up too (Ignition Benefits, PeopleKeep)”
“Half vent / half request for help. Our organization has 12 people. Likely hiring a few more next year, but headcount growth isn't the primary focus. Our provider last year essentially told us to leave group insurance because one employee had a child with major health issues. Our term plan ended in June of this year; we received a quote for a 200% cost increase. We only had a few weeks to figure it out. The other plan options were awful 20% co-insurance plan was the only option that matched o”
“Congratulations! Do you mind sharing what option you've chosen for healthcare, and roughly how much it costs to cover the whole fam?”
“This question is for owner operators, what do you do or have seen when it comes to Medicare coverage? Medicare Advantage? Medicare Supplement? What is the most popular and reliable? submitted by /u/aliassantiago [link] [comments]”
“I'm West Coast US but apparently I can't find any health insurance that's affordable on the private market and the staffing agency offers ins at same price (roughly $500-$700 a month). Any suggestions? Single adult male no dependents submitted by /u/Ok-Luck-7499 [link] [comments]”
“Hi all, I worked on our HRIS as an admin and was just beginning more training to expand further into HR when I was laid off. I did not get the chance to train on benefits admin, so I have a couple of questions. I was laid off at the end of June, right before their open enrollment for July. I had no problem electing Cobra coverage for Vision and Telemedicine in July; however, in August I encountered a problem on the payment portal where there was no option to submit a payment. So I contacted the”
“I got an offer from a startup and when I asked for info on the health insurance benefit they sent me a booklet with all the different available plans. However the premiums for the plans are not in there. I asked for further clarification and the response was that I'll be able to see the monthly payment once I'm at enrollment. Is this normal? Or what could I use to estimate the premiums? My wife has insurance for both of us from her job and we are trying to compare them. submitted b”
“I think you're correct. You can use your HRA to pay for out of pocket medical costs, including deductibles, but you can't use it to pay for premiums that are pre-taxed. I think it's covered in Revenue Ruling 2002-03. But I'm happy to be corrected if wrong. So the plan itself is probably legal. But I don't think you're allowed to use the HRA to reimburse yourself for the pre-taxed premiums.”
“This is legal, my work has the same benefit. It benefits your employer by getting your risk off the insurance plan. This is especially true if the city has a self-funded insurance plan. With you on the plan, their risk is basically unlimited. With you off the plan, their max risk is $11k. There’s usually some rules, like you must use a spouses plan, you can’t sign up for a marketplace plan and the HRA. The spouses plan, if a high deductible plan, generally cannot contribute to an HSA (though you”
“Yes my wife’s insurance would be paid pre-taxed income. So that’s my concern. She would pay premium pre tax, hence getting the tax benefit of lower taxable income. But then my job is saying I can get that 100% reimbursed through a tax free HRA. Just doesn’t feel right.”
“Is the spouse's insurance premiums paid with taxable income or pre-taxed income? Most insurance is paid using pre-taxed income for most employers”
“My city job currently has an HRA set up where they give us $2000 to use as health reimbursements throughout the year for eligible medical expenses. Now they want to increase that to $11,000 if employees opt of of city insurance and go with their spouse on their works plan. A way to save the city money. The city is saying in addition to deductibles copays prescriptions and other items, we can get reimbursed for the insurance premium my wife pays. This feels illegal in some form regarding taxes no”
“Thank you, based on what I know I had accessible MEC coverage for the overlapping months that I was enrolled in the marketplace plan. As soon as I enrolled in my new employers insurance I contacted them and terminated my marketplace insurance (since I truly believed active enrollment meant that you were disqualified not an offer) which only took effect the start of this year meaning I still had 11 months worth of coverage that I should’ve paid without APTC. At this point I spoken with both the m”
“My city job currently has an HRA set up where they give us $2000 to use as health reimbursements throughout the year for eligible medical expenses. Now they want to increase that to $11,000 if employees opt of of city insurance and go with their spouse on their works plan. A way to save the city money. The city is saying in addition to deductibles copays prescriptions and other items, we can get reimbursed for the insurance premium my wife pays. This feels illegal in some form regarding taxes no”
“I am 20+ year employee benefits consultant. I am already meeting with employers who have a 1/1 renewal. Typical employee count 100-500. Met with 3 last week. All projected to receive a 30%+ increase. None of them running terribly. Buckle up folks. Gonna be a fun 4th quarter...... submitted by /u/Orion_1981 [link] [comments]”
“yesterday I talked with a prospect regarding health insurance.and I give him Icici Lombard elevate plan. quotation cost is 15K. (male age 34/ female age 30 / Child age 9). but they said it's expensive. i explained him whole plane and other details but they said it's expensive. the. what I do on this situation. some have any idea or any other plan is cheaper than Icici Lombard plan? submitted by /u/Gain123123 [link] [comments]”
“Has anyone implemented IDX as an employee benefit or strategic partner? I’m trying to understand the actual costs beyond PEPM pricing. Were you charged implementation/setup, white-label, API integration, SSO, enrollment-file, annual platform, minimum commitment, or other fees? If you’re comfortable sharing approximate implementation costs and group size, that would be extremely helpful. submitted by /u/I_Love_Cybersecurity [link] [comments]”
“Looking for opinions on what would be a fair way to resolve this, particularly from anyone familiar with small-business benefits/taxes. I’m a W-2 healthcare professional at a small private practice (~20 employees). I like my employer a lot and have a very good relationship with him. This isn’t an adversarial situation — he’s been very supportive, but benefits administration is definitely not his area of expertise. My final written compensation agreement included: Immediate 401(k) eligibility 3%”
“Looking for opinions on what would be a fair way to resolve this, particularly from anyone familiar with small-business benefits/taxes. I’m a W-2 healthcare professional at a small private practice (~20 employees). I like my employer a lot and have a very good relationship with him. This isn’t an adversarial situation — he’s been very supportive, but benefits administration is definitely not his area of expertise. My final written compensation agreement included: Immediate 401(k) eligibility 3%”
“I’m wanting to know who here has had their employer switch from their normal PPO/HMO health plan to an ICHRA plan. My employer is switching us over next year and tbh, I’m terrified. I use a HDHP because I meet my max OOP each year. I have two specialists that I see and am prescribed multiple controlled meds as well as other non controlled meds. I know exactly how much I spend on my healthcare each year. I am a family of one, located in a small town outside a large city and also travel a lot. So”
“Is an LLC required or is a sole proprietorship acceptable for small business health insurance eligibility?”
“Old but my franchise in KY offers it to 30 hours minimum employees. But also this franchise offers 3 or 4 day work weeks. Anyone working the 4 day gets it. Anyone who wants more than 4 days has to pick up shifts”
“Is an HRA a viable way for a sole proprietor to access small-business health plans we otherwise couldn't get? This year our therapy costs will hit $21k. Since my income will exceed $500k, this expense realistically won't be deductible. I'm looking for the most cost-effective, lowest-effort option for health insurance for my family. So far, here's what I've found: - HSA/high-deductible plan: roughly $15k/year for a family of 3, on top of our $21k OOP therapy costs. - PPO with”
“Hello all, Ive been asking this in several places so hello again if applicable. I'm just starting my medical LLC (disregarded entity) and trying to panel with insurance companies. It seems like there's a discrepancy between what IRS wants and what Insurance companies want with W9 completion. IRS says i need to use my EIN but insurance seems to want me to use the LLCs EIN. I want to obtain group contract with payors to bill under LLC but Ive been told using my EIN may jeopardize this. Any”
“That's awesome. My startup is currently an LLC, but it looks like I can convert to an S-corp and give myself a W-2 to qualify. Can you share your broker's name? I am in WA as well.”
“Howdy, My employer is switching up our insurance, and has joined some sort of business union (a “multi employer welfare arrangement”) and I’m struggling to understand what it is and/or whether it’s sketchy. I gather that it’s a grandfathered plan, and that MEWAs aren’t really employer sponsored healthcare/are allowed to cut coverage normally required under the ACÁ. One thing they did was send us a sheet that listed a bunch of exclusions. It included a section for exclusions for “high-risk activi”
“Theres a company called Opolis thats trying to do something like this. I think they run it like a co-op you run your payroll through them and then you have access to group negotiated benefits. I think it suffered from the cold start problem in getting enough people to sign on to have a large enough network to make any difference in the rates they could negotiate with the monopolized insurers. I checked their rates for like 3 or 4 years and they never really beat the obamacare market rates for me”
“I believe Premera is the only EPO with UW/Hutch in network. Obviously Kaiser doesn’t have them, and I know Regence dropped them from their ACA plans (but not workplace plans) this year. I’m guessing it’s only time until Premera drops UW too. A friend in Chicago said that none of the major academic medical centers there take ACA plans anymore. So, it’s the networks that concern me. I see a number of specialists at UW, and for at least one of the specialties, Providence/Swedish and Franciscan/VM d”
“I manage HR functions for a small nonprofit. We just received our renewal rates for healthcare through our PEO and I'm curious what others are seeing in MA or across the US. Our plans are averaging a 9% increase - not unexpected, and I budgeted for 10%, but would be interested to hear what others are seeing as well. submitted by /u/wonder_woman_19 [link] [comments]”