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Exploring coverage options for small businesses

Deciding between group coverage & an HRA?

Wondering if traditional group coverageโ€”like a plan offered through the Small Business Health Options Program (SHOP)โ€”or a Health Reimbursement Arrangement (HRA) is right for your small business? Understanding eligibility requirements, coverage options, and costs can help you decide which option fits the needs of your small business and employees.
Read below to learn the differences between certain types of HRA's and traditional group plan coverage.

The difference between certain types of HRAs and traditional group coverage

ย HRAs for small employersIndividual coverage HRAs for employers of all sizesQualified small group plans, including SHOP
OverviewKnown as aย QSEHRA, this is for small employers to reimburse employees' qualifying medical expenses, like premiums for individual coverage or other expenses on a tax-free basis.Known as anย individual coverage HRA, this is for employers of any size to reimburse employees' qualifying medical expenses, like premiums for individual coverage or Medicare on a tax-free basis.Aย group health insurance planย offered by an insurance company for eligible small employers.
Reimbursement modelDefined contributionโ€”employers select how much money to contribute to employees, up to the allowed annual 2023 limit of $5,850 for individuals and $11,800 for households (increases annually for inflation).Defined contributionโ€”employers select how much money to contribute to employees and, if the employer chooses, to employeesโ€™ dependents.Defined benefitโ€”employers offer a plan, and in some cases are able to offer a selection of plans to their employees and, if the employer chooses, to employeesโ€™ dependents.
Eligible businessesGenerally, small employers with fewer than 50 employees (other than certain owners or their spouses) who don't offer other group health plan coverage.Employers of any size with at least one employee (other than certain owners or their spouses).Generally, small employers with 1-50 employees (other than certain owners or their spouses) may be eligible for SHOP coverage.
CoverageEmployees can generally choose how they use a QSEHRA as long as they use it for qualifying health care expenses, and they also have qualifying health coverage, like a plan from theย Individual Marketplace.Employees can generally choose how they use an individual coverage HRA as long as they use it for qualifying health care expenses, and have individual health insurance coverage, like a plan from theย Individual Marketplace.Employees have a plan or selection of plans to choose from that offer minimum essential coverage, based on what the employer offers.
EnrollmentEmployers can provide a QSEHRA at any time of the year, but they must give written notice to their employees 90 days before the beginning of each plan year. Employees with a newly provided QSEHRA, or who newly gained access to an existing QSEHRA (like newly hired employees) will be eligible for a Special Enrollment Period (SEP) to enroll in individual health insurance coverage in or outside of the Marketplace.Employers can offer an individual coverage HRA at any time of the year, but they must generally give written notice to their employees 90 days prior to the start of the individual coverage HRA plan year. Employees with a new individual coverage HRA offer will be eligible for a Special Enrollment Period (SEP) to enroll in individual health insurance coverage in or outside of the Marketplace.Small businesses generally can enroll any time of the year.
Employer contributionsSmall employers can decide what they'll contribute to their employees' health care costs, up to the annual maximum.Employers can decide what they contribute with no annual maximum.There's no contribution requirement for SHOP coverage, though to be eligible for the Small Business Health Care Tax Credit, employers must contribute at least 50% of the cost of premiums for all full-time employees who enroll in SHOP coverage.
Tax InformationQSEHRA reimbursements aren't taxed to the employee. If the QSEHRA is affordable for an employee, the employee and any covered dependents arenโ€™t allowed a premium tax credit for their Marketplace coverage. If the QSEHRA is unaffordable, the employee must reduce the amount of the advance payment of the premium tax credit (APTC) by the QSEHRA amount.Individual coverage HRA reimbursements aren't taxed to the employee. If an employee accepts the individual coverage HRA offer, no premium tax credit is allowed for the employee's Marketplace coverage. If the individual coverage HRA offer is considered affordable for an employee, the employee and any dependent(s) the HRA offer extends to aren't eligible for a premium tax credit for their Marketplace coverage. Employees who decline an unaffordable individual coverage HRA, may qualify for a premium tax credit for Marketplace coverage, if they are otherwise eligible.Group health plan contributions are generally not taxed to the employee. If a qualifying employer offers SHOP coverage, the employer may be eligible for the Small Business Health Care Tax Credit.
Learn moreLearn more about QSEHRAs.Learn more about individual coverage HRAs.Learn more about SHOP.

What's an excepted benefit HRA?

If you offer group coverage, you may be able to help reimburse your employees for certain health benefits up to an annual maximum of $2,100 for plan years beginning in 2024 (adjusted annually for inflation). Examples of reimbursable benefits include, vision or dental coverage, coinsurance and copayments for individual coverage, short-term health insurance, or other health care costs. You can't use this type of HRA to reimburse premiums for individual coverage, traditional group health plans (other than COBRA or other continuation coverage), or Medicare.ย Review frequently asked questions about HRAs for individual coverage and excepted benefitsย (PDF, 408 KB).

Employees: Understanding HRAs