Can a business with one or two employees get a group health plan?

Can an owner-only business get group coverage?

HealthCare.gov says a self-employed person with no employees cannot enroll in a SHOP plan, and a business generally needs at least one employee other than the owners or their spouses.

• SHOP is the small-business Marketplace. HealthCare.gov says a business generally needs 1 to 50 full-time equivalent employees to offer it. Some states may allow SHOP for businesses with up to 100 employees. Check before you assume the line in your state.
• No employees means individual coverage. If you run the business and have no employees, HealthCare.gov says you probably will not qualify for group coverage. You can buy an individual Marketplace plan instead. Open enrollment for 2027.
• A spouse on the payroll does not, by itself, create a group. HealthCare.gov says that if your only employee is a spouse or a family member, you generally cannot use SHOP to cover both of you.
• The owner can join the plan the employees join. HealthCare.gov says yes, as long as at least one employee who is not an owner, a partner, or a family member also enrolls.

SHOP is not the only group plan. Plans from multiple carriers outside SHOP have their own rules. Those rules still vary by state. This page is the general picture, not a quote for your business. A group health quote, including a large group, comes from contacting Seth directly. Book a call or use the contact form. There is no online quote link for group coverage.

Who counts as that one employee?

HealthCare.gov looks for at least one full-time equivalent employee other than owners, spouses, family members of owners, and partners.

• Full time generally means 30 or more hours a week. You offer SHOP coverage to all full-time employees. You do not have to offer it to part-time employees or seasonal workers, though you can.
• The employee HealthCare.gov describes is a common-law employee on payroll. The SHOP employer guide points to the IRS description of a common-law employee. An owner, a sole proprietor, and the owner's spouse do not fill that spot.
• A 1099 contractor is generally not that employee. Someone you pay as an independent contractor is not the same thing as a common-law employee. Whether a person is an employee depends on the facts. This page cannot decide that for your business.
• Two part-time people can add up. HealthCare.gov's employer guide says two half-time employees generally equal one full-time equivalent. Use the SHOP calculator on HealthCare.gov rather than guessing the count.

What participation rate does a small-group plan require?

For SHOP, HealthCare.gov says most states require at least 70% of the employees offered coverage to enroll or to have other coverage, and some states use a different rate.

• Most states use 70%. That is the share of employees you offer coverage to who must enroll, or who already have other coverage. Other coverage can include a spouse's job plan, Medicare, Medicaid, TRICARE, veterans' programs, or an individual plan. Those people are not counted as rejecting the offer.
• Texas and Louisiana list 75%. HealthCare.gov's SHOP page lists a 75% minimum participation rate for Texas and for Louisiana.
• Tennessee lists 50%. HealthCare.gov lists 50% for Tennessee. Other states on that exception list include Iowa, Mississippi, New Hampshire, South Dakota, and Utah. If your state is not named here, check the SHOP page. Do not assume 70%.
• November 15 through December 15 waives the SHOP rate. HealthCare.gov says you do not have to meet the minimum participation requirement between those dates in any year.
• A plan outside SHOP can use a different rate. Multiple carriers set their own participation rules, and the state can change them. Seth checks the rule on the plan you are actually considering.

You can start SHOP coverage any time of year if you qualify. It does not follow the individual open enrollment calendar. See who qualifies for SHOP.

Does the business have to pay part of the premium?

Many group plans expect the business to contribute toward the premium, and that share is set by the plan and the state rather than by one national rule.

• There is no single percentage on this page. HealthCare.gov's SHOP eligibility rules cover who must be offered coverage and what share must enroll. They do not publish one employer contribution rate for every plan in every state.
• The quote is where the contribution shows up. If a plan requires the business to pay a share, that share is in the quote. A number in a brochure is not a promise that your business will be approved.
• A tax credit is separate from eligibility. Some smaller employers who enroll in SHOP may qualify for a small-business health care tax credit. Whether your business qualifies is a tax question. This page does not answer it.

What if there are two owners and no other employee?

Two owners and no other employee may or may not qualify, because SHOP still looks for an employee who is not an owner, a partner, or a family member, and a plan outside SHOP can read that situation differently.

• SHOP does not treat a second owner as the required employee. Owners, partners, and their family members are the people HealthCare.gov sets aside when it counts the employee you need.
• Plans outside SHOP, from multiple carriers, may read two owners differently. That depends on the state, the business type, and the plan. It is not a rule this page can state as true everywhere.
• Bring the payroll facts to the call. Who is on a W-2, who is an owner, and who is a spouse are the facts that change the answer. Seth can look at the plan. The page cannot.

What can a very small business compare instead?

Owners often compare an individual Marketplace plan, a private PPO that asks health questions, and a fixed indemnity plan that pays a set cash benefit.

• An individual Marketplace plan. This is the usual path when the business does not qualify for group coverage. Enrollment follows a calendar unless you have a special enrollment period. 2027 open enrollment and coverage outside open enrollment.
• A private major medical PPO. You answer health questions. The price is based on your health. A healthy applicant may pay less than they would on the Marketplace. That is not a promise. Private major medical PPO plans. One option is on its own page. Private major medical.
• A short-term or supplemental plan. This is individual coverage, not a group quote. A short-term plan has an end date. National General plans.
• A fixed indemnity plan. It pays a set cash benefit for a covered service. It is not major medical, and it is not health insurance. Fixed indemnity plans.

None of these is automatically the better fit. A Marketplace plan can still be the right one, including when you want a plan that does not ask health questions. Use the which-fits worksheet and then talk with Seth at Branded Insurance Group. Call (786) 606-0139.