health insurance for small business in pennsylvania

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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.

Small Business Health Insurance Plans In Pa – Buyers Guide

Jun 26, 2021

Small business health insurance in Pa has become very affordable for both owners and employees. Tax credits and incentives are easily available to business owners with fewer than 25 full-time employees. We make it easy to find the lowest rates private and group offered by the most respected insurance companies in Pennsylvania. We help the self-employed find quality solutions for their daily needs. The more choices you and your workers have, the more likely you are going to have a satisfied work environment. A simplified buying process helps make enrollment much easier.

Affordable Care Act Legislation

The Patent Protection And Affordable Care Act (passed by Congress in 2010), gives special tax consideration to small businesses that provide medical insurance to employees. These tax breaks will help you save money, since much of the healthcare legislation was not overturned or substantially changed. We work with owners to explain what impact some of these changes may have on their income. Whether you are insured with Blue Cross Blue Shield, Geisinger, Keystone, Aetna, Independence Blue Cross, UPMC, or any other carrier, you will be affected.

If additional Government plans are fully implemented, we will show you the most important benefits, and how they can lower your premiums. It’s possible that within the next several years, additional lower-cost policies may be offered with specific limitations that are not found on Exchange contracts. It’s also possible that the Medicare-eligible age requirement changes, and lowers the age to 55 or 62.

Small Business Health Care Tax Credit

50% (previously 35%) of the cost of providing qualified health insurance is returned as a Small Business Health Care Tax Credit . For example, if the monthly premium to cover employees is $10,000, $60,000 is subtracted from the tax liability. Also, vision and dental costs will qualify for the exemption. In addition to the 25-employee rule previously mentioned, the average annual wage of workers must be less than $54,200, and a qualifying arrangement must be maintained.

Although this won’t pay all of the small business owner’s cost, it will put a huge dent in the outlay, and allow you to spend money on other important items, such as purchasing new equipment, hiring additional employees, or upgrading current facilities. The $54,200 amount is indexed for inflation and increases every year. However, the small business can not utilize a credit for healthcare premiums provided for the owner. Sole proprietors, partners, and members of partnership LLCs can take advantage of a tax deduction, but not a tax credit.

Tax-exempt organizations (Section 501c of the Internal Revenue Code) may be eligible for the tax credit. A limitation is placed on the amount of withheld payroll taxes during the calendar year. The credit can be taken for a maximum of two consecutive years. Cost-of-living adjustments are applied to yearly wage phaseout amounts.

What also may help bigger companies is that the credit is determined by full-time workers and not part-time workers. So hypothetically, you could manage a company with 200 employees. If less than 25 are full-time, you probably will receive the tax help. If there are persons that need individual medical coverage, you can view information here . Association plans are also available. We also expect that future legal challenges will not substantially alter many of the new laws that have already been passed, that impact businesses. However, private medical coverage options are substantially changing, as “Obamacare” is slowly tweaked and improved. Replacement will probably not occur.

To stay competitive in the marketplace, it’s equally important to have skilled employees, and lower manufacturing and production costs than the competition. And naturally, to attract skilled employees, you may have to provide superior healthcare benefits, which isn’t always cheap. However, often, there is a simple solution that is very easy to administer. And all of the “brand name” carriers offer it. A combination of HSA options, and low-deductible comprehensive plans, provide multiple choices that satisfy the great majority of employees. Many large insurers offer Group benefits to companies with 2-50 employees.

Workman’s Compensation

The goals of the Agency are very direct. They seek to: Improve the claims process and hasten benefit payments to consumers, improve financial and physical infrastructure, create a quality and safe work environment, and help injured parties return to work as quickly as possible, with job-placement assistance. The Pennsylvania Workers Compensation Act was passed more than 100 years ago, and provides assistance to workers that have been injured at work regardless of fault. Occupational diseases and injuries are both a covered benefit.

Workman’s compensation issues are handled directly by the Pa Department of Labor and Industry. Their website is located here . If you suffer a work-related injury or illness, you may be eligible to file a claim. Wage-loss compensation and death benefits may be paid to yourself or your survivors, if applicable.  Medical treatment and vocational rehabilitation are also covered. If you are actively employed, you are probably covered by these benefits. You can also find additional information on finding a job, finding and hiring employees, searching for an interpreter, job gateways, and online business registration.

Federal and state statistics are constantly updated, and any legislative changes are also posted. Additional related Agencies include Federal Black Lung Program, Energy Employees Occupational Illness Compensation Program, Protecting Our Workers and Ensuring Reemployment Initiative, Longshore and Harbor Worker’s Compensation Program, and Federal Employees’ Compensation Program. Coverage is provided through licensed carriers and the State Workers Insurance Fund.

Workplace laws and safety standard information is also provided by the Department. Legislation is constantly changing, and it’s important to be aware of the impact of any new laws that may impact your company or your workers. Also, if a worker receiving benefits has a change in health, the payout could be impacted. Eligibility for Medicaid or Medicare could also impact the amount of compensation received. Sudden changes in household income may impact eligibility in several state plans. Pandemics (such as COVID) can impact the size and duration of subsidy payments for Pa Pennie Exchange plans.

Pa Small Group Membership By County (Top 20)

Allegheny – 48,704

Montgomery – 43,962

Bucks – 33,419

Philadelphia – 29,089

Chester – 25,456

Delaware – 21,153

Lancaster – 11,353

Westmoreland – 10,334

Berks – 8,891

Erie – 8,862

Washington – 7,666

Lehigh – 7,656

Butler – 7,231

Dauphin – 7,051

York – 6,608

Cumberland – 6,200

Northampton – 6,141

Luzerne – 4,358

Blair – 3,975

Lackawanna – 3,505

The SHOP Marketplace

What is the SHOP Marketplace? It’s the “Small Business Health Options Program” that assists employers and small business owners in finding affordable qualified medical and dental coverage for their employees. It’s a component of the Affordable Care Act that pertains to business entities with 50 or less full-time workers. Three years ago, coverage was extended to employers with 100 workers.

Previous choices were provided by several carriers that did not offer Pa private coverage (UnitedHealthcare and Aetna). In 2022, additional companies may re-enter the market, as more plan options become available. Future legislation may also impact policy options by rewarding small and large companies with tax incentives. Business-owners that pay workers with a 1099 may qualify for small group coverage.

The Small Business Health Care Tax Credit (previously discussed) is available for companies with less than 25 full-time employees (FTE). The average salary of employees also must be $50,000 or less, and at least half of the cost of benefits must be paid by the employer. Plans are offered to full-time employees. Seasonal workers typically are not included when calculating the percentage of full-time workers. An exception is if they work more than 120 days throughout the year.

There is a prerequisite of offering benefits to all employees. Therefore, specific workers can not be singled out for inclusion or exclusion. Spouses can also be offered coverage, but changes to plans can not be made throughout the year (only during Open Enrollment). A “special” enrollment period will be available for unique situations, such as changes in family status, divorce, death of spouse, or loss of qualified medical benefits.

Employees generally like the SHOP option since they can compare and review quotes from several companies and inform the owner which plans they prefer. Health only, dental only, or both, can be offered to employees and their dependents. The owner determines how much of the premium they will pay. Enrollment is simplified since a broker can help with the online process. There are no fees, and often, HSA options ate offered. Employees can opt out of plans at any time. However, if outside of the Open enrollment period, alternative plans may have to be selected.

Least Expensive SHOP Rates (Monthly) In Pennsylvania

Bronze Tier

$172.96 – Up to age 20

$189.44 – Age 21

$215.01 – Age 30

$242.10 – Age 40

$338.34 – Age 50

$514.14 – Age 60

Silver Tier

$184.17 – Up to age 20

$201.72 – Age 21

$228.95 – Age 30

$257.80 – Age 40

$360.27 – Age 50

$547.47 – Age 60

$224.14 – Up to age 20

$245.50 – Age 21

$278.64 – Age 30

$313.75 – Age 40

$438.46 – Age 50

$666.29 – Age 60

Platinum Tier

$298.58 – Up to age 20

$327.03 – Age 21

$371.18 – Age 30

$417.94 – Age 40

$584.08 – Age 50

$887.56 – Age 60

Consider An HSA

The combination of a Group high-deductible catastrophic medical plan with an HSA option is an affordable way to keep everyone happy. The business owner pays less premiums and the employee takes a little more risk. But when this type of plan is properly explained to workers, they often to embrace the concept and look forward to the possibility of accumulating savings while reducing their taxes. Consecutive years of low claims can result in quicker accumulation of funds inside the savings account.

These funds can be utilized in the future to help pay for deductibles or other out-of-pocket expenses. Deposits can be systematically made or at the time when large medical bills are due. Expansion of deductible medical expenses is expected within the next three years. Additional tax breaks may also be offered, depending upon proposed legislation. Dental and vision expenses also qualify for tax deductions.

Individual 2021 HSA annual out-of-pocket expenses can not exceed $7,000 for individuals, and $14,000 for a family. Annual contributions are capped at $3,600 for individuals and $7,200 per family. “Catch-up” contributions of $1,000 are allowed for persons over age 55. HDHP minimum deductibles are $1,400 for an individual plan and $2,800 for family coverage.

Employees are rewarded for a healthier lifestyle and numerous discounts to health spas, YMCAs, fitness centers and many other exercise-related facilities. And why not? A healthier worker is more productive and saves the insurance company millions of dollars in potential large claims. You can find Pa HSA Rates on our website. We’ll help calculate your tax deductions and federal subsidies. We also help you choose the most cost-efficient combination of deductible, coinsurance, and maximum out-of-pocket expenses. The side account is generally managed by a bank or similar financial institution.

The concept of a reimbursement account is usually viewed favorably among employees, since they have more control over how benefits are delivered and how expenses are paid. If money is not used for the current year, it can roll over to the next year. Funds can be easily withdrawn at any time since the customer controls the account. It’s also very possible that in future years, (perhaps 2021) a combination of HSA deposits and contributions may provide additional reasons to select this type of policy. More funds may be allowed to be deposited and more favorable tax treatment is also possible.

With this type of coverage, the biggest variable is the deductible that the employee will have. A lower deductible is the most attractive and of course, the most expensive. But business owners can “buy down” the deductible for an inexpensive price. Thus, everyone is satisfied with the benefits they have and the price they are paying for a quality medical group policy. Dependent rates are usually low, even when they are between the ages of 21-26. Once off their parents’ policies, low-cost options remain available along with guarantee-issue plans.

HSA Example

For example, a high $5,000 deductible offered to workers with 100% preventive benefits will keep premiums down for both employer and employee. But optional $2,500 and $1,000 options (and sometimes $500) may be available from the insurer. These lower-deductible options may be very attractive to specific workers that are critical to your business and must be retained. $6,000 and $7,000 deduct�ble options may also be very cost-effective options for healthy families. However, if maternity benefits are expected to be used within the next 12 months, it’s important to select an option with the lowest maximum out-of-pocket expenses.

Depending on how the separate fund is set up, an employee who is leaving, may be able to take their accumulation with them �nd either transfer to another account, or receive the proceeds in cash. Although there may be tax ramifications, this option becomes a very attractive benefit offered by the owner of the company. And as a result, perhaps better, more skilled workers will become available. Newly-hired workers can also retain an existing account without penalties or taxes.

Many major investment firms will easily handle the rollover. Fidelity, Charles Schwab, and Ameritrade are three popular choices.  Accumulated funds may be used by Seniors paying qualified Medicare expenses. If the HDHP is no longer active, additional deposits into the regular account can not be made. Funds may be withdrawn, although there may be a limited tax liability. During this time, investment income is still earned and monthly administrative expenses (if applicable) will be charged.

Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)

A QSEHRA offers individuals  free money if they work for a company with less than 50 employees. The worker utilizes the funds for their healthcare coverage. More than $800 per month (per family) can be contributed by the employer. Many expenses are eligible for deductions, including deductibles, prescription drugs, copays, and policy premiums.

The employer can choose the amount of funds contributed to the workers. The maximum amount is listed below, although each year, this amount is adjusted for inflation. Each plan must meet minimum essential coverage requirements. Policies can be offered at any time throughout the year as long as employees receive a 90-day advanced notice.

Often described as a small business HRA, these types of plans help a business offer quality medical plans to employees regardless of health conditions. Since they are not considered qualified group plans by the IRS, ERISA requirements do not apply. Also, payment that reimburse worker’s medical expenses are not included in an employee’s gross income if the plan meets MEC (minimum essential coverage) requirements.

Proof of usage must be submitted, along with a description, cost, and date of purchase. The item is reviewed, and reimbursement is sent from the funds that have been provided for qualified expenses. A monthly allowance of available expenses is determined by the company. The maximum amount is $5,150 per person and $10,450 per family.

Let Us Help You Shop

One of the most important methods to reduce small business premiums is the simplest! Shop and compare. Not necessarily 10 different companies, but approximately 2-4 carriers including your local Blue Cross company. Highmark, Keystone and Capital Blue Cross may not always have the lowest rates (although often they do), but they can negotiate lower healthcare costs by utilizing the power of their networks. Often, the savings is in excess of 25%-50%.

Aetna and UnitedHealthcare, since they are national companies, should also regularly be included in the quote process. Humana and Cigna are more active in the Senior market, rather than the private small business market. Additional companies, including Kaiser, may offer Keystone State options in the future. Smaller regional carriers often provide competitively-priced options along with localized networks. Geisinger, for example, is very popular in the Central portion of the state.

Health insurance premiums on small and large businesses tend to increase quicker as the makeup of the group changes. As more healthy employees leave the group, premiums quickly increase. For that reason, it’s always wise to either obtain new quotes, or negotiate with your current provider every 2-3 years. It will be one of the best financial decisions you ever made. The Department Of Revenue may also be able to assist in some of your tax issues, including refunds and rebates.

You can use our free quote request form to provide some basic details needed to compare premiums. We’ll utilize every available resource to find the most affordable options. We help you find the cheapest Pa small business healthcare plans that will be easy on your budget and keep your workers loyal and productive. As new legislation is passed, we will provide updates, and explain how new laws will impact employers and their workers.

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Consumer Assistance in Pennsylvania

The Pennsylvania Department of Insurance operates the State’s Consumer Assistance Program. Staff can answer questions about health insurance regulations, rights, and responsibilities. They can help you file a complaint or appeal a health plan decision. Get consumer help with a problem or question .

Medicaid in Pennsylvania

You can apply for Medicaid in Pennsylvania by contacting your state Medicaid agency .

SHOP Health Insurance Marketplace® in Pennsylvania

If your small business is located in Pennsylvania, you can use the Pennie website to learn more about offering your employees health coverage.

SHOP Health Insurance Marketplace® for Employees in Pennsylvania

If your employer offers SHOP health coverage in Pennsylvania, you should contact your employer or visit the Pennie website for more information.

Health Insurance Marketplace® in Pennsylvania

If you live in Pennsylvania, you’ll use the Pennie website to enroll in health coverage.

CHIP in Pennsylvania

Pennsylvania CHIP covers uninsured children in families with moderate incomes that are too high to qualify for Medicaid. You can find out whether your children qualify for Pennsylvania CHIP right now. Fill out a Marketplace application and find out whether your children qualify. Learn more about Pennsylvania CHIP .

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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Pennsylvania Group Health Insurance & Employee Benefit Plans

Taylor Benefits Insurance has been revolutionizing the healthcare insurance industry in Pennsylvania for over 25 years.  We offer group health insurance and provide the most affordable and comprehensive employee benefits packages .  Not only do we offer health benefits for your company, but we also offer around-the-clock, top-notch service, so you will always have an agent available to help with your insurance needs.

Pennsylvania Large Group Health Insurance Plans

The ACA made many changes to  health insurance for employees of large companies . While most companies already provide health insurance coverage to their workers, the ACA ensures that all health plans meet specific standards for services and affordability. For example, the affordability requirement limits the amount of employees’ premiums that subscribers can be required to pay.

The maximum is 9.12 percent of a subscriber’s gross income for individual coverage. That means that if an employee has a salary of $50,000, the maximum charge for their share is $4,560 annually.

Also, the ACA lists ten minimum essential coverage that all plans must cover:

• Ambulatory patient services (outpatient care)
• Emergency services
• Hospitalization, including surgical and medical
• Maternity and newborn care, including delivery
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative services and devices
• Laboratory services
• Preventative and wellness services, including chronic disease management
• Pediatric services, including dental and vision care for children under the age of 19

Pennsylvania added to this list with the following health insurance coverage requirements:

• Durable medical equipment
• Diabetes care
• Reconstructive surgery following mastectomy
• Infusion therapy (chemotherapy)

Employers can avoid those state-level requirements if they purchase their own health insurance rather than purchasing insurance, but self-funding doesn’t grant an exemption from the ACA requirements.

Pennsylvania Small Business Health Insurance Plans

Small employers aren’t required to provide  health insurance for their employees . For many, the cost seems prohibitive. One reason is that per capita costs may be higher for small businesses since insurers evaluate the risks in the employee pool to determine subscriber rates.

Small businesses may find affordable small business health insurance plans through the SHOP (Small Business Health Options) program developed as part of the Affordable Care Act (ACA). Your Taylor Benefits Insurance consultant can help you explore potential options. Further, small businesses with less than 25 employees may be eligible for small business health insurance tax credit.

Pennsylvania Employee Benefits Plans and Employee Benefits Packages

Pennsylvania does not require employers to offer paid or unpaid time off to workers. However, employees value their benefits packages, and many companies offer some time off to recruit and retain talent. In addition, paid time off and expanded family leave (often unpaid) are among the most requested benefits after health insurance.

When possible, employers may add other benefits, like retirement savings plans, life and disability insurance, dental and vision coverage, and more. Many employees value flexible scheduling, particularly if they are balancing family demands with work requirements. Companies may find it cost-effective to allow workers to shift their schedules or offer work-from-home options on request.

Taylor Benefits specializes in the following:

• Group health insurance plans
• Medical, dental , and vision insurance
• Employee benefits and wellness plans
• Affordable Care Act (ACA) compliance
• Disability insurance ( short and long-term )
• Group retirement plans
• 401(k) plans , set-up and servicing
• Employee pensions
• Health savings plans (HSA)
• Group life insurance
• Long-term care plans
• Section 125 cafeteria plans
• Pennsylvania large group health insurance

Taylor Benefits operates differently than most insurance providers by functioning as an independent agent.  This allows us the unique ability to fully customize the perfect group package by drawing from any number of traditional insurance providers in order to get you the best deal possible.

Taylor Benefits Insurance also recognizes that insurance requirements are in near-constant flux in Pennsylvania. Because we understand the local conditions and regulations, you can rest assured we offer group coverage to all businesses operating in this unique state.

Contact us today at the number on the top of the page for a FREE estimate and available group benefits options in Pennsylvania, or complete the simple form on the right for a no-obligation, customized proposal for your Pennsylvania-based business.

How does the Affordable Care Act affect my Pennsylvania-based business?

The  Affordable Care Act  (ACA), casually called  Obamacare , made it easier for the uninsured to receive comprehensive health insurance, but it also threw a wrench in the workings of many businesses.  Previously approved programs no longer met federally-mandated minimums after the implementation, so companies found themselves scrambling to become compliant.   Pennsylvania  businesses were substantially  affected due to the changes .

Taylor Benefits has been able to assist hundreds of businesses in Pennsylvania since the Affordable Care Act emerged, and we continue to be the industry leader in group policies and employee benefits plans.  Our first-hand knowledge of the law, coupled with our diverse resources, consistently allows us to create packages that are ACA-compliant without adversely impacting the company’s bottom line.

If you need this type of attentive insurance assistance and are operating a Pennsylvania-based business, please complete the form on the right or call the number at the top of the page for a FREE, customized proposal guaranteed to meet your needs exactly.

Frequently Asked Questions About Health Insurance And Employee Benefits Plans in Pennsylvania

In Pennsylvania, as is the case elsewhere in the US, comprehensive health insurance coverage is a tremendous relief for employees who need health care. Pennsylvania created a state-run health insurance exchange (Pennie) to assist employers and individual subscribers with accessing coverage and managing ACA compliance.

Below are some frequently asked questions about Pennsylvania health insurance:

What Is The Average Cost Of Large Group Health Insurance Plans In Pennsylvania?

90 percent of Pennsylvania workers have employer-sponsored insurance available. For single coverage, the average employer contribution is $5,878, absorbing 81 percent of the premium expense.

Which Pennsylvania Health Insurance Companies Offer Small Business Group Policies?

Health insurance for small businesses in Pennsylvania is offered by:

• eHealthInsurance
• Blue Shield
• Coventry Corp. Group
• Kaiser Foundation Group
• Unitedhealth Group
• Metropolitan Group
• HIP Insurance Group
• Carefirst Inc. Group
• UHC of California
• Humana Group

Pennsylvania Employee Benefits Packages: What Should They Include?

Among the health benefits an employee may expect to receive in Pennsylvania are:

• Health Insurance
• Vision Insurance
• Retirement & Pension
• Section 125 Cafeteria Plan
• Short and Long-Term Disability Insurance
• Life Insurance
• Long-Term Care
• Dental Insurance

These options will help to protect and care for your employees and may assist you in recruiting and retaining high-quality workers.

What Is The Average Cost Of Employee Benefits?

Benefits often add around 30 percent to the cost of each employee. The amount a company invests depends on the health insurance plan and the benefits it provides.

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Featured Testimonial

Todd Taylor with Taylor Benefits gives our small business the kind of personal service we need. Insurance benefits are important to our employees and Todd helps us find a balance between benefits and value. Todd responds immediately to my phone calls & e-mails. He has even gotten in touch with me on a Sunday when we were in need of coverage answers immediately. We are very pleased with the hands-on service Todd and his staff provide.”

- Ken and Linda Orvick, Orvick Management Group, Inc.

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Pennie works collaboratively with other state agencies to make sure eligible Pennsylvanians receive the services they need.

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Pennsylvania’s Medical Assistance program provides you and your family with several health care options.

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You can apply if you do not know if you are eligible.  There are different ways to apply. Please choose the option that suits you best.

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Food banks offer food assistance services  through a network of nearly 3,000 local charitable partners — including food pantries, soup kitchens, feeding programs, and shelters. Please contact your local food bank directly for assistance.

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WIC offers nutrition services, breastfeeding support, health care and social service referrals, and healthy foods to eligible families.

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The Supplemental Nutrition Assistance Program (SNAP) helps eligible low-income households supplement their food budget. 

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Thousands die every year waiting for a donated organ, but it doesn’t have to be this way. Register now, and you could save up to 8 lives. DLPA works to educate PA residents, build awareness about the importance of organ and tissue donation and increase the number of signups.

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Pennie is not currently operating a SHOP program but if you are interested in individual coverage for yourself and/or employees, please click here to read our factsheet about how Pennie potentially could lower your health coverage costs. Click here for Spanish version

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Pennsylvania health insurance plans

You have more insurance options for your health than you think, Pennsylvania

If you’re self-employed or without insurance from your employer — in other words, you’re looking for individual or family health insurance in Pennsylvania — you might be looking for Affordable Care Act insurance, what's often called Obamacare. However, we want to make you aware of the whole range of individual and family insurance products we have available in your state.

Plans for health insurance coverage in Pennsylvania

Short term health insurance in pennsylvania.

A temporary medical insurance plan like  short term health insurance 1  underwritten by Golden Rule Insurance Company may provide:

• Budget-friendly monthly payments
• Health care coverage while you search for a long term option

Questions about short term insurance? Call 1-844-711-0168   / TTY 711 to talk to a representative.

Supplemental, dental and vision insurance in Pennsylvania

Hospital & doctor insurance.

Health ProtectorGuard fixed indemnity insurance , 2  underwritten by Golden Rule Insurance Company, can supplement your major medical plan by paying cash for eligible, covered medical services, like a doctor visit, a trip to urgent care or a surgical procedure.

• No deductibles or copays to pay first
• Benefits paid regardless of other insurance
• Money to pay costs not covered by major medical plans, like a deductible

Pennsylvania dental plans

Dental insurance plans, underwritten by Golden Rule Insurance Company, have no age limit restrictions. 3 They offer coverage for the dental services many medical insurance plans don’t include. 

Pennsylvania vision plans

Vision insurance plans, underwritten by Golden Rule Insurance Company, have no age limit restrictions. 3 They offer coverage for the vision services many medical insurance plans don’t include. 

Accident & critical illness insurance

Accidental injuries and critical illness happen when you least expect them. Those unexpected expenses can strain any budget.  Accident insurance 2 and  critical illness insurance 2  can help by paying cash benefits for covered injuries or illnesses.

The Accident Pro series of products, underwritten by Golden Rule Insurance Company, combines accident insurance with critical illness, hospitalization, and accidental death and dismemberment coverage all in one. Some plans are guaranteed issue, meaning your application won’t be turned down for preexisting conditions.

Browse coverage options in Pennsylvania

From Philadelphia to Pittsburgh, Allentown to Erie, explore these  Pennsylvania health insurance options and more  that may be available now.

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Need help finding a plan?

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Health insurance for individuals who are  65 or older , or those under 65 who may qualify because of a disability or another special situation.

Call 1-844-232-1426 to learn more.

Medicaid plans

We offer low cost or no cost health insurance plans for those with limited incomes.

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Get a full analysis of Pennsylvania business insurance costs, companies & coverage.

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Get help from one of our Pennsylvania independent agents

They understand your risks and will find you the coverage you need.

Find the Best Business Insurance Options in Pennsylvania

To be fully protected, your Pennsylvania business should be equipped with a business insurance policy. With the coverage provided by business insurance, your company can stay afloat after what would've been a financially devastating disaster such as a fire or break-in. Though Pennsylvania is an attractive area for business owners to set up shop for many reasons, they must have the right protection in place first.

Pennsylvania has about one million small businesses currently, and the two-and-a-half million small business employees need protection just as much as their companies do. Fortunately, an independent insurance agent in Pennsylvania can help you find the right kind of business insurance policy for your company. But for starters, here's more about Pennsylvania business insurance.

Many different insurance carriers in Pennsylvania sell business insurance, but some are better than others. That's why we put together a list of only the best for you. Check out our top picks for business insurance in Pennsylvania when you're in need of coverage for your company.

• Liberty Mutual: Liberty Mutual sells many types of business insurance and personal products. The insurance company is also a Fortune 500 company with excellent ratings from AM Best and the Better Business Bureau (BBB) and offers 24/7 claims reporting.
• Progressive: Progressive sells many types of coverage along with business insurance. The insurance company also has outstanding financial strength ratings, many discounts, and offers 24/7/365 customer service. 
• Nationwide: Nationwide sells business insurance and many personal products. The insurance company has great ratings by both AM Best and the BBB and offers 24/7 claims reporting.
• Travelers: Travelers also sells business insurance and many personal coverages. The insurance company is known for its great customer service and many discounts.

A Pennsylvania independent insurance agent can help you find the right business insurance policy for your company from one of these top-rated carriers.

Pennsylvania Business Insurance Requirements

In Pennsylvania, your business must carry workers' compensation coverage, with very few exceptions. This coverage is mandated by state law for most businesses. Though other types of business insurance are optional in Pennsylvania, many companies greatly benefit from having business income insurance, which can provide reimbursement for typical revenue and employee payroll during covered closures. Businesses may also want to consider getting commercial property insurance to protect company property, such as buildings or inventory, against theft and other disasters. Commercial auto insurance is also a good consideration for companies that have delivery vehicles.

Pennsylvania state law requires businesses to have workers' comp, with very few exceptions. As a result, the only state-mandated type of business insurance is:

• Workers' compensation

Optional Business Insurance Coverage in Pennsylvania:

• Commercial auto insurance
• Professional liability insurance
• Commercial property insurance
• Commercial general liability insurance
• Cyber liability insurance
• Business income insurance

Working with a Pennsylvania independent insurance agent is an efficient way of assembling the type of business insurance policy your company needs.

What Business Insurance Covers in Pennsylvania

Every business insurance policy in Pennsylvania can be customized to meet your needs. So, policies aren't standard, meaning the coverage they provide varies depending on what you select. You might want several more coverages in addition to workers' comp, even if they aren't technically mandatory. Your business insurance policy might be complete for your specific company once it has workers' comp, business income coverage, commercial auto coverage, commercial general liability coverage, and commercial property coverage, while other businesses will require more or less coverage. A Pennsylvania independent insurance agent can help recommend the exact coverage options your business would benefit from the most.

Liability Coverage Options for Small Businesses in Pennsylvania

Your Pennsylvania business is always vulnerable to lawsuits. That's why having liability coverage is crucial. You may want one or all of these major types of business liability coverage:

• Commercial general liability insurance: This reimburses you for the costs of lawsuits after third-party claims of bodily injury or personal property damage caused by your business.
• Professional liability insurance: This reimburses you for the costs of lawsuits after claims of incorrect or improper advice given or services performed by your business.
• Cyber liability insurance: This reimburses you for the costs of lawsuits after data breaches and cybercrimes that can expose sensitive information like customer credit card numbers or employee personal records.

A Pennsylvania independent insurance agent can help your business get set up with all the liability coverage it requires.

Property Coverage Options for Small Businesses in Pennsylvania

You'll also want to have protection for your business's property. Consider adding this type of coverage to your Pennsylvania business insurance policy:

• Commercial property insurance: This can reimburse you for the costs of theft, damage, or destruction to commercial property, including buildings and inventory.

Your Pennsylvania independent insurance agent will help you select the right amount of commercial property coverage.

Other Insurance Options for Small Business Owners in Pennsylvania

There are still other types of business insurance you might need for your company. Look into adding the following coverages to complete your policy:

• Commercial auto insurance: This can reimburse you for the costs of incidents with company vehicles, such as lawsuits, accidents, theft, etc.
• Business income insurance: This can reimburse you for expenses during temporary closures after covered incidents like fires by providing a continued income stream and employee payroll while your business is closed.

A Pennsylvania independent insurance agent can help you make sure your business insurance policy includes every type of coverage you need.

Business insurance policies in Pennsylvania aren't standard, and neither are their premiums. If your business needs more coverage in larger amounts, you'll pay more for your coverage. Also, if your business is in a riskier industry by nature, such as construction, you can expect to pay more for your coverage. Basically, the larger your business is, the more coverage it needs, and the riskier its operations are, the more the business insurance policy will cost.

How does your city measure up to the national average?

Number of businesses in the US:  30,819,176

Burglary rate per 1,000 residents in the US:  3.76

Auto theft rate per 1,000 vehicles in the US:  2.29

How Does Your Pennsylvania City Measure Up?

Allentown, pa common coverage options.

Commercial property insurance: Businesses in Allentown are vulnerable to all kinds of threats to their property, including from natural disasters and vandalism. Having commercial property insurance can help you get reimbursed for damage or destruction to your business's buildings and inventory, including if it gets stolen.

Commercial auto insurance: All businesses in Allentown also need commercial auto insurance if they use company vehicles for deliveries, mobile services, etc. This coverage can help reimburse you for lawsuit costs if your company vehicles get involved in accidents, as well as for repairs or replacement if they get stolen, vandalized, etc.

Workers' compensation: With very few exceptions, every business in Allentown with employees must have workers' comp. This coverage can pay for medical treatment for employees who get injured or ill due to the job environment or work tasks. The trade for offering this coverage is that your business is exempt from employee lawsuits for similar incidents, and from lawsuits filed by their families.

Erie, PA Common Coverage Options

Commercial property insurance: Businesses in Erie are vulnerable to all kinds of threats to their property, including from natural disasters and vandalism. Having commercial property insurance can help you get reimbursed for damage or destruction to your business's buildings and inventory, including if it gets stolen.

Commercial auto insurance: All businesses in Erie also need commercial auto insurance if they use company vehicles for deliveries, mobile services, etc. This coverage can help reimburse you for lawsuit costs if your company vehicles get involved in accidents, as well as for repairs or replacement if they get stolen, vandalized, etc.

Workers' compensation: With very few exceptions, every business in Erie with employees must have workers' comp. This coverage can pay for medical treatment for employees who get injured or ill due to the job environment or work tasks. The trade for offering this coverage is that your business is exempt from employee lawsuits for similar incidents, and from lawsuits filed by their families.

Philadelphia, PA Common Coverage Options

Commercial property insurance: Businesses in Philadelphia are vulnerable to all kinds of threats to their property, including from natural disasters and vandalism. Having commercial property insurance can help you get reimbursed for damage or destruction to your business's buildings and inventory, including if it gets stolen.

Commercial auto insurance: All businesses in Philadelphia also need commercial auto insurance if they use company vehicles for deliveries, mobile services, etc. This coverage can help reimburse you for lawsuit costs if your company vehicles get involved in accidents, as well as for repairs or replacement if they get stolen, vandalized, etc.

Workers' compensation: With very few exceptions, every business in Philadelphia with employees must have workers' comp. This coverage can pay for medical treatment for employees who get injured or ill due to the job environment or work tasks. The trade for offering this coverage is that your business is exempt from employee lawsuits for similar incidents, and from lawsuits filed by their families.

Pittsburgh, PA Common Coverage Options

Commercial property insurance: Businesses in Pittsburgh are vulnerable to all kinds of threats to their property, including from natural disasters and vandalism. Having commercial property insurance can help you get reimbursed for damage or destruction to your business's buildings and inventory, including if it gets stolen.

Commercial auto insurance: All businesses in Pittsburgh also need commercial auto insurance if they use company vehicles for deliveries, mobile services, etc. This coverage can help reimburse you for lawsuit costs if your company vehicles get involved in accidents, as well as for repairs or replacement if they get stolen, vandalized, etc.

Workers' compensation: With very few exceptions, every business in Pittsburgh with employees must have workers' comp. This coverage can pay for medical treatment for employees who get injured or ill due to the job environment or work tasks. The trade for offering this coverage is that your business is exempt from employee lawsuits for similar incidents, and from lawsuits filed by their families.

Reading, PA Common Coverage Options

Commercial property insurance: Businesses in Reading are vulnerable to all kinds of threats to their property, including from natural disasters and vandalism. Having commercial property insurance can help you get reimbursed for damage or destruction to your business's buildings and inventory, including if it gets stolen.

Commercial auto insurance: All businesses in Reading also need commercial auto insurance if they use company vehicles for deliveries, mobile services, etc. This coverage can help reimburse you for lawsuit costs if your company vehicles get involved in accidents, as well as for repairs or replacement if they get stolen, vandalized, etc.

Workers' compensation: With very few exceptions, every business in Reading with employees must have workers' comp. This coverage can pay for medical treatment for employees who get injured or ill due to the job environment or work tasks. The trade for offering this coverage is that your business is exempt from employee lawsuits for similar incidents, and from lawsuits filed by their families.

Pennsylvania Business Insurance FAQ

How much does business insurance cost in pennsylvania.

Pennsylvania business insurance policies aren't standard, and neither are their premiums. Your policy's rates will be influenced by many factors, including your business's size, location, claims history, industry, coverages needed, and more.

Is business insurance required in Pennsylvania?

Yes, if your business has any employees, you'll be required to carry workers' compensation insurance. There are very few exceptions to this rule.

What does business insurance cover in Pennsylvania?

Pennsylvania business insurance will cover whatever you select in your policy. You may choose to add workers' comp, commercial auto insurance, commercial property insurance, general liability insurance, business income insurance, and others to your business insurance policy as a good starting place.

What does business general liability insurance cover in Pennsylvania?

Business liability insurance in Pennsylvania covers third-party lawsuits filed against your company. Third-party claims must be for bodily injury or personal property damage for this coverage to kick in. Reimbursement can be for attorney, court, and settlement fees if your business gets sued.

Are there any business health insurance plans in Pennsylvania?

Yes, and health insurance plans in Pennsylvania are optional if you have under 50 employees. Your business may qualify for tax credits on this coverage if you have fewer than 25 full-time employees.

What are the best business insurance companies in Pennsylvania?

Our research found that the best small business insurance companies in Pennsylvania currently are Liberty Mutual , Nationwide , Progressive , and Travelers . These companies were selected based on financial strength ratings, customer service reviews, policy options and rates, discount options, and more.

Why work with an independent insurance agent when shopping for business insurance in Pennsylvania?

An independent insurance agent in Pennsylvania can help make your coverage journey much more efficient. They can shop and compare policies from many different Pennsylvania business insurance companies, then present you with only the options that offer the best blend of coverage and cost.

Do You Know What Your Business Insurance in Pennsylvania Covers?

https://www.dli.pa.gov/Individuals/Workers-Compensation/publications/Pages/WC%20Act/WC-Act-Landing-Page.aspx

https://www.insurance.pa.gov/Coverage/Pages/For-Employers.aspx

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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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November 01, 2023

ACA open enrollment has begun; here's how to pick a health insurance plan

Pennsylvania residents have until jan. 15 to apply for coverage. in new jersey, the deadline is jan. 31.

Pennsylvania can enroll in Affordable Care Act health insurance plans through the state marketplace through Jan. 15. In New Jersey, the deadline is Jan. 31.

Nov. 1 marks the beginning of open enrollment, the roughly two-month period when Americans without employer-sponsored health insurance or Medicaid can choose plans on the marketplace. And this year, shoppers should steel themselves for a financial hit.

Monthly premiums are expected to climb largely across the board. KFF, a nonprofit that researches health policy, reported a nationwide 6.3% increase in premiums for the average bronze plan, which is the cheapest tier of Affordable Care Act plans. Pennsylvanians will see an average 3.9% spike in premiums, state officials announced in September. 

Most people qualify for financial assistance. Pennie, the state marketplace for Pennsylvania, and Get Covered NJ, the marketplace for New Jersey, both say that 9 out of 10 customers are eligible for savings that lower their monthly payments. These credits can be calculated online on the state marketplaces or, for residents of states without their own systems, on healthcare.gov .

Pennsylvania residents will also have more options for 2024, as both Jefferson Health Plans and Highmark are participating in the state marketplace for the first time. And Independence Blue Cross is launching a new portfolio of dental plans alongside its health plans in the Philadelphia region.

What else do you need to know to enroll? Here's a guide to the deadlines, qualifications and assistance options in New Jersey and Pennsylvania:

How do I sign up for a plan?

Both Pennie and Get Covered NJ offer users the option to browse plans before they register. But to proceed, you'll eventually need to create an online account, providing information like your birthday, social security number and household income. You can then start an application and select a health insurance plan.

Do I qualify for a marketplace plan?

In Pennsylvania, state residents who are U.S. citizens or nationals, or have  qualified immigration status , can enroll in a Pennie plan. Incarcerated individuals are ineligible, unless they are pending the disposition of charges.

In New Jersey, you must be a state resident and U.S. citizen or national to enroll in a Get Covered NJ marketplace plan. " Qualified " immigrants — such as refugees, aslyees and green card holders — also can enroll. Anyone currently incarcerated is not eligible.

Can I get help choosing or enrolling in a plan?

Brokers and assisters are available to help Pennsylvania and New Jersey residents. While both receive training, there are a few key differences in their services.

Assisters generally help enrollees navigate the marketplace and application process. Their assistance is free, but they cannot make specific recommendations on health insurance plans. You can search for assisters by zip code on Pennie or Get Covered NJ. Additionally, Pennie is offering in-person assister events across Philadelphia, Montgomery, Allegheny, Dauphin, Lehigh, Lancaster, Northampton, Greene and Washington counties every day in November and December.

Brokers, conversely, can make recommendations, but they may only be able to sell plans from specific insurance companies. Brokers are typically paid a commission by insurance carriers, making their assistance free to customers, unless they request additional, specialized services. You can search for local brokers on Pennie and Get Covered NJ.

Customer service representatives are also available to help in either state. For Pennie, the number is 1-844-844-8040. For Get Covered NJ, it's 1-833-677-1010.

How long do I have to enroll?

Pennsylvania residents have until Dec. 15 to apply for insurance coverage that will begin on Jan. 1. Open enrollment then ends on Jan. 15.

New Jersey residents have a little more time. Dec. 31 is the deadline to enroll for coverage beginning on Jan. 1, while Jan. 31 is the hard deadline for open enrollment.

Once open enrollment ends, only those who experience "qualifying life events" — such as getting married or losing a job — may enroll in an ACA plan at a date outside that period. Low-income residents also may obtain an exception. In New Jersey, those with an annual income up to 200% of the federal poverty level can enroll at any time of the year. In Pennsylvania, the threshold is at or below 150% of the federal poverty level.

Follow Kristin & PhillyVoice on Twitter: @kristin_hunt | @thePhillyVoice Like us on Facebook: PhillyVoice Have a news tip ? Let us know.

Kristin Hunt PhillyVoice Staff

[email protected]

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Small Business Trends

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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Enrollment is open for ACA health plans. Here's what's to know about choosing one

Julie Appleby

Open enrollment started Nov. 1 for Affordable Care Act health insurance marketplaces. Carmel Wroth/NPR hide caption

Open enrollment started Nov. 1 for Affordable Care Act health insurance marketplaces.

For millions of Americans who buy their own health insurance through the Affordable Care Act marketplace, the end of the year brings a day of reckoning: It's time to compare benefits and prices, and consider changing to a new plan, or enroll for the first time.

Open enrollment starts Wednesday for the ACA's federal and state exchanges. Consumers can go online, call, or seek help from a broker or other assister to learn their 2024 coverage options, calculate their potential subsidies, or change plans.

In most states, open enrollment lasts through Jan. 15 , although some states have different time periods. California's, for example, is longer, open until Jan. 31 , but Idaho's runs from Oct. 15 to Dec. 15 . In most states enrollment must occur by Dec. 15 to get coverage that begins Jan. 1.

Health policy experts and brokers recommend all ACA policyholders at least look at next year's options, because prices — and the doctors and hospitals in plans' networks — may have changed. Here's what else you need to know.

People bumped from Medicaid may be eligible, and could make it another record year for signups

ACA plans are now well entrenched — an estimated 16.3 million people signed up during open enrollment last year. This year may see even larger numbers. Enhanced subsidies first approved during the height of the COVID pandemic remain available, and some states have boosted financial help in other ways.

In addition, millions of people nationwide are losing Medicaid coverage as states reassess their eligibility for the first time since early in the pandemic. If you're one of those ousted, be aware you could be eligible for an ACA plan. You can sign up as soon as you know you're losing Medicaid coverage — even outside of the open enrollment season.

Applying for health insurance doesn't have to be confusing. Here's a handy glossary

Shots - Health News

In some states, hundreds of thousands dropped from medicaid, assistance from brokers comes with new strings.

An important caution: Don't wait until the last minute, especially if you are seeking help from a broker. Consumers this year will be asked to certify that they voluntarily agreed to brokers' assistance and that their income and other information provided by brokers is accurate.

It's a good protection for both parties, said broker Joshua Brooker , founder of PA Health Advocates in Pennsylvania. But brokers are concerned the requirement could cause delays, especially if clients wait until right before the end of open enrollment to apply.

"Brokers will need to stop what they are doing right at the end before they click 'submit' and wait for the consumer to sign a statement saying they reviewed the policy," Brooker said.

Your premiums could go up — shop around

While some health plans are lowering premiums for next year, many are increasing them, often by 2% to 10% , according to a Peterson-KFF Health System Tracker initial review of rate requests. The median increase, based on a weighted average across its plans for each insurer, was 6%.

Premiums, and whether they go up or down, vary widely by region and insurer.

Experts say that's a big reason to log on to the federal website, healthcare.gov , in the 32 states that use it, or on to the insurance marketplace for one of the 18 states and the District of Columbia that run their own . Changing insurers might mean a lower premium.

"It's very localized," said Sabrina Corlette , research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. "People should shop to maximize their premium tax credit, although that might require not only changing to a new insurance plan, but potentially also a new network of providers."

Most people buying their own coverage qualify for the tax credit, which is a subsidy to offset some, or even all, of their monthly premium. Subsidies are based partly on the premium of the second-lowest-priced silver-level plan in a region. When those go up or down, possibly from a new insurer entering the market with low initial rates, it affects the subsidy amount.

Household income is also a factor. Subsidies are on a sliding scale based on income.

Subsidies were enhanced during the pandemic, both to increase the amount enrollees could receive and to allow more families to qualify. Those enhancements were extended through 2025 by President Joe Biden's Inflation Reduction Act, passed last year.

Online calculators, including one at healthcare.gov , can provide subsidy estimates.

Medicare shoppers often face a barrage of unsolicited calls and aggressive ads

You may qualify for lower deductibles and copays.

In addition to the premium subsidies, most ACA enrollees qualify for reduced deductibles, copayments, and other types of cost sharing if their income is no more than 2.5 times the federal poverty level, or about $75,000 for a family of four, or about $36,450 for a single-person household.

ACA plans are grouped into colored tiers — bronze, silver, gold, and platinum — based largely on how much cost sharing they require. Bronze plans offer the lowest premiums but usually the highest copayments and deductibles. Platinum plans carry the highest premiums but the lowest out-of-pocket expenses for care.

Cost-sharing reductions are available only in silver-level plans and are more generous for those on the lower end of the income scale. New this year: To help more people qualify, the federal marketplace will automatically switch eligible people to a silver plan for next year if they are currently enrolled in a bronze plan, as long as the enrollee has not made an adjustment in coverage themselves.

There are safeguards built in, said insurance expert and broker Louise Norris , so that people are auto-enrolled in a plan with the same network of medical providers and a similar or lower premium. Additionally, nine of the states that run their own marketplaces — California, Colorado, Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Vermont, and Washington — have enhanced their cost-sharing reduction programs by extending eligibility or increasing benefits.

Some 26-year-olds will get to stay on parents' plans longer

Happy birthday! Existing federal marketplace rules allowing adult children to stay on their parents' plans though the calendar year in which they turn 26, rather than lose coverage on their 26th birthday, were codified into regulation .

States that run their own markets can set similar rules, and some already allow for longer periods on a parent's plan.

Networks may be small – check that your doctors are covered

Insurance plans often try to reduce premiums by partnering with a limited set of doctors, hospitals, and other providers. Those can change year to year, which is why insurance experts like Norris say enrollees should always check their plans during open enrollment to ensure their preferred physicians and medical centers are included in the network.

It's also a good idea, Norris said, to look closely for changes in prescription drug coverage or copayments.

"The general message is, don't assume anything and make sure you check to see who is in the network," Norris said.

Last year, the Biden administration set rules requiring health plans to have enough in-network providers to meet specific driving time and distance standards. A proposal to limit how long patients wait for a routine appointment has been delayed until 2025.

What we still don't know

A few things remain uncertain as the end of the year approaches. For example, the Biden administration proposed this summer to reverse a Trump-era rule that allowed short-term insurance plans to be sold for coverage periods of up to a year.

Short-term plans are not ACA-compliant, and many have fewer benefits and can set restrictions on coverage, including barring people with health conditions from purchasing them. As a result, they are far less expensive than ACA plans. The Biden proposal would restrict them to coverage periods of four months, but the rule isn't final.

Also pending: a final rule that would allow people to sign up for ACA coverage if they were brought to the U.S. as children by parents lacking permanent legal status — a group known as "Dreamers."

KFF Health News , formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

• health insurance subsidies
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• Affordable Care Act
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