Health insurance guide
Small Business Health Insurance
This guide to small business health insurance explains how small-group plans, the SHOP tax credit, and health reimbursement arrangements work, plus what employer coverage costs on average, using IRS, HealthCare.gov, and KFF sources checked in October 2026.
Blake Insurance Group is an independent agency serving clients by phone, email, and online in states where we are licensed; coverage depends on the insurer, the policy, and underwriting.
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Small-group coverage and the tax credit
Small employers generally buy small-group coverage, which HealthCare.gov describes as for businesses with 1 to 50 employees, through an insurer, an agent, or a SHOP-registered broker, any time of year. Employers with fewer than 25 full-time-equivalent employees who pay at least half of employee-only premiums for a SHOP plan may qualify for the Small Business Health Care Tax Credit, worth up to 50% of premiums for two consecutive years, according to the IRS.
QSEHRA and ICHRA
Health reimbursement arrangements are another option. A QSEHRA lets employers with fewer than 50 full-time-equivalent employees that don’t offer a group plan reimburse individual premiums and medical costs, up to $6,450 for self-only and $13,100 for family coverage in 2026. An ICHRA, available to employers of any size, reimburses employees who buy individual coverage, and an affordable ICHRA rules out the premium tax credit.
What employer coverage costs
KFF’s 2025 Employer Health Benefits Survey found average annual premiums of $9,325 for single coverage and $26,993 for family coverage, with workers contributing $1,440 and $6,850 on average. At small firms, workers paid 36% of the family premium on average, versus 23% at larger firms. The ACA’s employer mandate applies to employers with 50 or more full-time workers, including equivalents.
Premium tax credits after 2025
The enhanced premium tax credits that lowered marketplace premiums from 2021 through 2025 expired on December 31, 2025. The House passed a three-year extension in January 2026, but the Senate didn’t, and no extension had been enacted as of October 2026. That means the original rules apply again: premium tax credits are generally available from 100% to 400% of the federal poverty level, and households above 400%, about $63,840 for a single person for 2027 coverage, get no credit at all.
KFF had estimated that subsidized enrollees’ average premium payments would more than double, from $888 in 2025 to $1,904 in 2026, if the enhancements expired. For 2027 coverage, the IRS caps the benchmark silver premium for eligible households at between 2.15% and 10.22% of income, depending on income.
| Household size | 100% of poverty | 400% of poverty |
|---|---|---|
| 1 | $15,960 | $63,840 |
| 2 | $21,640 | $86,560 |
| 3 | $27,320 | $109,280 |
| 4 | $33,000 | $132,000 |
48 states and DC. Source: HHS poverty guidelines (Federal Register, Jan. 15, 2026); 400% figures computed. Alaska and Hawaii are higher.
When you can enroll
Open Enrollment for 2027 coverage on HealthCare.gov runs November 1, 2026 through January 15, 2027, and you generally need to enroll by December 15 for coverage starting January 1. A 2025 federal rule would have ended enrollment December 15, but a federal court vacated that change in June 2026; HHS has appealed, so check HealthCare.gov or your state marketplace for the latest dates. Some state marketplaces set their own deadlines: California and New York run through January 31, 2027, and Virginia through January 29.
Outside Open Enrollment, you need a Special Enrollment Period, usually triggered by a life event such as losing other coverage, moving, marriage, or having a baby, and generally lasting 60 days. The monthly low-income Special Enrollment Period that let people under 150% of the poverty level enroll any time has ended, and since 2026 people who enroll through an income-based SEP not tied to a life event can’t get premium subsidies.
Plan levels and cost limits
Marketplace plans are grouped into metal levels, bronze, silver, gold, and platinum, by how costs are shared between you and the plan. Bronze plans have the lowest premiums and highest out-of-pocket costs; gold and platinum the reverse. Silver plans matter for subsidies: the premium tax credit is based on the second-lowest-cost silver plan in your area, and people with lower incomes can get extra cost-sharing reductions only on silver plans.
Marketplace plans cap in-network out-of-pocket costs for essential health benefits. The federal maximum is $10,600 for an individual and $21,200 for a family in 2026, rising to $12,000 and $24,000 for 2027, according to CMS.
Premium trends
Premiums rose sharply for 2026: KFF reports the average benchmark premium for a 40-year-old climbed about 26%, from $497 to $625 a month. Even so, 22.97 million people selected marketplace plans during 2026 Open Enrollment, according to CMS. Preliminary 2027 rate filings averaged a 15.9% increase, according to a September 2026 analysis by Manatt.
Insurers leaving for 2027
Several insurers are leaving marketplaces for 2027. Cigna won’t offer individual and family plans in any of its 11 states, Molina plans to narrow to about six states, UnitedHealthcare is leaving Georgia’s marketplace, and Aetna left all marketplaces for 2026, according to KFF, the companies, and trade press. If your insurer is leaving, you’ll need to pick a new plan during Open Enrollment.
Short-term plans
Short-term health plans aren’t ACA plans: they can exclude pre-existing conditions and don’t have to cover all essential benefits. A 2024 federal rule limits them to three months, or four with renewals, but federal agencies said in August 2025 they won’t prioritize enforcing that rule until new rules are issued, and states can set their own limits. Check your state’s rules before buying one.
Turning 65
If you’re turning 65, you’ll generally move from marketplace coverage to Medicare, which has its own enrollment periods. Keeping a marketplace plan after you become eligible for premium-free Part A usually means losing any premium tax credit.
Reporting income and reconciliation
Premium tax credits are based on your estimated income and reconciled on your federal tax return, so report income and household changes to the marketplace during the year. If you received more credit than you qualified for, you may owe some back at tax time.
Getting help
Licensed agents who are registered with the marketplace can help you compare plans, estimate your subsidy, and enroll. Using an agent doesn’t change the premium for a marketplace plan; agents are paid by the insurers. Confirm an agent’s license through your state insurance department.
Ways to lower your cost
- Report income accurately. Subsidies are based on your estimated household income.
- Check silver plans if your income qualifies you for cost-sharing reductions.
- Consider a bronze plan if you rarely use care; bronze plans now count as HSA-compatible.
- Check for job-based coverage offers, which can affect subsidy eligibility.
- See if you qualify for Medicaid or, for children, CHIP.
- Re-shop every year, since insurers enter and leave markets.
Checking a plan and insurer
- Network. Confirm your doctors and hospitals are in network.
- Drugs. Check your prescriptions on the plan’s formulary.
- Total cost. Compare premiums, deductibles, and the out-of-pocket maximum.
- Subsidy. Make sure the price reflects any premium tax credit you qualify for.
- Agent license. Confirm the agent is licensed in your state.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- ASTHO: Enhanced premium tax credit developments (Jan. 2026)
- HealthCare Insider: Will you qualify for an ACA subsidy in 2027? (Oct. 2026)
- KFF: Marketplace premium payments if enhanced credits expire
- IRS Rev. Proc. 2026-26: 2027 applicable percentages
- Federal Register: 2026 HHS poverty guidelines (Jan. 15, 2026)
- healthinsurance.org: When is the next open enrollment period? (Oct. 2026)
- HealthCare Insider: Marketplace deadlines for 2027 coverage (Sept. 2026)
- The Kory Agency: 2027 ACA open enrollment date changes (Sept. 2026)
- Becker's Payer: HHS appeals decision vacating 2025 marketplace rule provisions
- healthinsurance.org: What happened to the low-income SEP? (May 2026)
- Kansas Health Institute: What's changing on the ACA marketplace (Aug. 2026)
- CMS: 2027 premium adjustment and cost-sharing parameters (Jan. 2026)
- U.S. Department of Labor: Short-term limited-duration insurance statement (Aug. 2025)
- KFF: Marketplace average benchmark premiums by state
- KFF: Marketplace insurers by state
- KFF: Status of state Medicaid expansion (Oct. 2026)
- CMS: Marketplace 2026 Open Enrollment report (Jan. 2026)
- Manatt: Preliminary 2027 ACA rates (Sept. 2026)
- HealthCare.gov: SHOP Marketplace overview
- IRS: Small Business Health Care Tax Credit
- IRS: Employer shared responsibility provisions
- healthinsurance.org: QSEHRA
- CMS: Individual coverage HRAs (training deck)
- KFF: Employer Health Benefits Survey 2025
- KFF: Tracking insurer participation changes in the ACA marketplaces in 2027
- NAIC: What are my health plan options for 2027? (Oct. 2026)
What to have ready for a health insurance quote
These details help an agent quote accurately.
- Household. Everyone in your tax household and their dates of birth.
- Income. Your expected 2027 household income.
- Doctors and drugs. Providers and prescriptions you want covered.
- Current coverage. Any job-based, Medicaid, or other coverage offers.
- ZIP code. Plans and prices vary by county.
Small Business Health Insurance FAQs
What counts as small group?
Generally 1 to 50 employees; some states use up to 100.
Is there a tax credit?
Yes, up to 50% of premiums for qualifying employers under 25 FTEs.
Can I reimburse individual plans instead?
Yes, through a QSEHRA or ICHRA.
What do employer plans cost?
KFF’s 2025 average single premium was $9,325 a year.
Related guides
Important information
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Health insurance figures. Subsidy rules, enrollment dates, and premiums on this page were checked against the listed sources in October 2026 and can change. Confirm with HealthCare.gov or your state marketplace.
Company names. Company names are trademarks of their owners. Blake Insurance Group isn’t affiliated with the companies described unless a partner link says so, and a company named here may not be available through us. Facts checked October 2026.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
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