November 06, 2014 Business Resources

A Small Business Owner’s Guide to Health Care Reform

Small businesses are the backbone of the American economy, but they are bearing the brunt of some tough regulations, thanks to the Affordable Care Act (ACA). I’d like to use this opportunity to offer some tips on how small business owners can get the biggest bang for their health care bucks.

What is a small employer? New York state defines small businesses as those having 50 or fewer employees. In 2016, that number is set to increase to 100 or fewer. If your business falls into one of these categories, then you are not required to provide coverage to employees under the employer mandate.

However, you’re not completely off the hook. The ACA is imposing a series of new taxes and fees that will likely increase health care costs for small businesses. In addition, small businesses that offer coverage must provide certain essential health benefits that include emergency services, hospitalization, maternity and newborn care, prescription drugs, pediatric dental coverage, mental health and substance abuse services, preventive care, wellness benefits, and other services.

The Small Business Marketplace provides several coverage options for your employees, including a single health plan or a few plans from which your employees can choose. You can also offer your staff a defined contribution (i.e., an allowance) and let them choose their own plan. If you participate in the Marketplace as a small business owner, you might become eligible for tax breaks if you have fewer than 25 full-time employees or if your workers’ average wages are less than $50,000 per year.

Sole proprietors. A sole proprietorship is a business owned and operated by a single person and is not considered a small business. These folks must adhere to the individual mandate, which requires them to either obtain coverage or pay a penalty.

How can I purchase coverage for my employees? You have two options for purchasing coverage:

  1. Directly from a health plan
  2. Work with a broker
  3. Small Business Marketplace

Purchasing health coverage is not only a significant expense for an employer, it’s also crucial for maintaining a healthy workforce and providing quality benefits for your employees. That’s why working with a health plan representative who will answer questions and offer guidance will help ensure that you’re making the best possible choices.

What questions should I ask before selecting health care plans for my employees?

  • How broad is the provider network and prescription drug formulary? From doctors and hospitals to pharmacies and urgent care centers, you want to make certain that your employees have a solid network of providers from which to choose. Likewise, a comprehensive drug formulary will ensure that their prescription needs are met.
  • What are standard and non-standard plans? A standard plan is a federally mandated, qualified health plan that is sold through the Marketplace. A non-standard plan could include different kinds of cost-sharing arrangements or benefits.
  • What wellness benefits are offered through the health care plans I’m considering? Some plans include gym memberships, weight-loss programs, or fitness classes. CDPHP® can work with you to find a plan that includes the benefits that are most important to your employees.

Make the most of your health care dollars

CDPHP is here to provide you with the ultimate value solution. There’s a lot to learn in the ever-changing insurance world, and we’re staying on top of the requirements, benefits, and ways to save money – for everyone.

Photo by Tax Credits / CC BY

John D. Bennett, MD, FACC, FACP
About the Author

John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.

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