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Industry Insights
April 4, 2025
5 min. read

Health Insurance for 1099 Contractors: Navigating the Landscape

Industry Insights

As technology rapidly evolves in 2025, U.S.-based business owners are stepping up their game to minimize contractor turnover. One of the most impactful ways to retain top-tier talent is by offering comprehensive healthcare benefits. With the gig economy continuing to grow, access to low-cost employee health benefits is no longer a perk—it’s a necessity. Looking back at 2024 and ahead to 2025, small businesses face unique challenges in standing out from competitors while holding onto quality contractors.

The 2024 Workforce Transformation

Last year was a pivotal moment for contractor and contingent workforce benefits, with major shifts in how businesses approached healthcare. As remote and hybrid work models became the norm, business owners had to rethink their strategies to accommodate the increasing demand for flexible benefits.

According to the Society for Human Resource Management (SHRM), 62% of companies expanded their benefits offerings for contingent workers in 2024, recognizing the competitive advantage that comprehensive healthcare provides.

Another key shift was the rising emphasis on holistic wellness. There was a notable increase in out-of-network claims from holistic health practitioners, signaling that workers are looking for more than just basic coverage. Reviewing your benefits package regularly and keeping contractors informed of new offerings can make a significant impact on retention and satisfaction.

By the end of 2024, it became clear that contractors want flexible, personalized benefits that adapt to their changing needs. Providing healthcare options that move with them could mean the difference between a long-term partnership and frequent turnover.

Why Health Benefits Matter More Than Ever

The numbers speak for themselves: 89% of Americans still prefer employer-sponsored health coverage. In the gig economy, this preference has only intensified over the last four years, becoming a key factor in career decision-making.

In today’s competitive job market, offering health benefits isn’t just about compliance—it’s a strategic move that sets businesses apart. When top talent has multiple opportunities to choose from, a strong healthcare package can be the deciding factor.

The Real-World Impact

Leading contractor platforms like Wingspan—a modern payroll solution for 1099 workers—have demonstrated the direct impact of benefits on contractor satisfaction and retention. Providing affordable healthcare options can reduce contractor churn by 10%, translating into a threefold increase in billable hours each week.

For platforms like Wingspan, partnering with Meridio, a provider specializing in affordable health benefits for contractors, was a game-changer. With seamless onboarding and instant access to expert healthcare support, businesses saw improvements in contractor satisfaction and loyalty.

Emerging HR and Staffing Trends in 2025

Gone are the days of one-size-fits-all healthcare. This year, businesses are shifting toward personalized, AI-driven benefits solutions. Think of it as a benefits ecosystem designed for the modern workforce.

AI-powered recommendation engines are now guiding contractors through benefits selection, ensuring they get the best-fit plan without hassle. However, human support remains essential—customer care teams will continue to provide hands-on assistance when needed.

Expect to see an increase in modular health coverage, allowing businesses to offer tailored wellness programs. Recognizing that each contractor has unique healthcare needs, companies are expanding access to benefits for part-time employees, seasonal workers, and freelancers alike.

Technology-Enabled Benefits Management

The integration of technology is revolutionizing how businesses manage contractor benefits. New digital platforms offer real-time health stipend tracking, blockchain-powered benefits verification, and centralized access to payroll reports, invoices, and hiring data—all in one place.

The Shift Toward Holistic Wellness

In 2025, mental health, financial wellness, and preventative care are at the forefront of benefits offerings. Today’s workforce values a proactive approach to well-being, and businesses that acknowledge this will stand out.

Robust mental health support is now a necessity, not a luxury. Offering coverage that includes psychiatrists and psychologists can significantly impact contractor retention. A strong behavioral health component within a benefits package can make all the difference in whether a contractor stays or moves on.

Financial wellness is another critical area. Contractors may not be full-time employees, but they still want financial stability. Offering options like 401(k) plans with employer matching can provide long-term security without reinventing the wheel.

Practical Solutions for 1099 Contractor Health Benefits

If you’re looking to enhance your contractor benefits program, consider these flexible options:

  • Health Reimbursement Arrangements (HRAs): HRAs provide tax-free reimbursements for healthcare expenses, allowing businesses to maintain cost control while giving contractors the flexibility to choose their own coverage.
  • Flexible Health Stipends: Monthly allowances for healthcare expenses let contractors manage their own coverage while minimizing out-of-pocket costs at the time of service. They also require minimal administrative oversight, making them an attractive option for businesses.
  • Direct Primary Care (DPC) Subscriptions: A newer approach to benefits, DPC plans offer predictable monthly costs for routine and preventive care, providing a streamlined healthcare experience without the complexities of traditional insurance.

The Role of Technology in Benefits Delivery

In 2025, AI-powered benefits platforms are simplifying enrollment, streamlining administration, and providing real-time insights into benefits utilization. Companies like Meridio remove the burden of benefits management so business owners can focus on growth while ensuring their teams have access to quality healthcare.

The Competitive Advantage of Contractor Benefits

Businesses that prioritize contractor health benefits in 2025 will gain a significant edge in attracting and retaining top-tier talent. Reducing turnover-related costs, enhancing company culture, and strengthening brand reputation are just a few of the advantages of offering comprehensive benefits.

Meridio: Your Partner in Contractor Healthcare Solutions

At Meridio, we specialize in transparent, affordable health benefits designed for the modern workforce. Our ACA-compliant health plans provide competitive coverage across all 50 states, making benefits administration simple and stress-free.

If you’re ready to revolutionize your contractor benefits strategy, let Meridio help you build a competitive, future-proof approach. See how easy it is to offer affordable health benefits to your employees—download our step-by-step guide below.

Industry Insights
October 20, 2023
6 min. read

Unlocking the Power of Preventive Care for Your Health in 6 Easy Steps

Industry Insights

Prioritizing preventative care services is crucial for maintaining a healthy and happy household. In this blog, we will explore six practical tips on how to make the most of your preventative care services and create a thriving household.

1. Establish a Strong Doctor-Patient Relationship: 

The foundation of effective preventative care lies in having a reliable and trustworthy healthcare provider. Even if you’ve been with the same practice for years, ask yourself, “Am I pleased? Does this doctor have my best interest at heart? Are they trying to get to the bottom of my symptoms to help me be the healthiest version of myself?”

Take the time to research and choose a primary care physician who aligns with your family's values and needs. Building a strong doctor-patient relationship fosters open communication, encourages transparency, and allows for personalized preventive care plans tailored to your family's unique circumstances.

If you’re not sure where to start when trying to find a new physician, start with your trusted circle of friends and peers, look at reviews on multiple sites to gain perspective, and of course be sure the physician is in your health plans network. 

2. Schedule Regular Check-ups:

Regular check-ups are the cornerstone of preventative care. Make it a priority to schedule routine visits for every family member, even if they appear to be in good health. These visits allow healthcare professionals to conduct thorough assessments, identify potential health risks, and provide guidance on lifestyle modifications that can prevent future complications. 

If you’re unsure what is considered a preventative care visit, refer to your health plan summary of details or call the customer service number on the back of your insurance card. For each member of your family, these visits will look different and have a different frequency. For example, children visit the doctor for preventative care more often than middle-aged adults. 

Staying on top of your preventative care visits will help you stay ahead of serious health diagnoses, help prevent human suffering, and help decrease the amount of time off you’ll need in the future. Studies show that workers who avoid medical care, end up missing more work because of serious illness down the road. Remember, prevention is always better than cure! 

Using your health benefits before you get sick, here's what you need to know.

3. Stay Up-to-date with Vaccinations:

Vaccinations are a critical aspect of preventative care, especially for children. You can find the recommended schedule for childhood vaccinations by the American Academy of Pediatrics HERE. Most often these visits are covered by insurance programs and would be considered part of your child's preventative and wellness checks. 

Ensure that everyone in your household receives age-appropriate vaccinations according to the recommended immunization schedule for adults set by the Centers for Disease Control. Vaccinations protect against a variety of illnesses, preventing the spread of diseases within your family and the wider community. 

4. Screenings and Preventative Tests:

Many health conditions can be detected early through screenings and preventative tests. Keep track of recommended screenings such as mammograms, pap smears, cholesterol checks, blood pressure monitoring, and colonoscopies. Your physician can provide you with a detailed list of screenings they would recommend for someone your age. 

Once again, avoiding medical care for routine exams can lead to late diagnosis, increased pain and suffering, limited care options, and lastly decreased survival rates for serious illnesses. Discuss these tests with your healthcare provider and ensure that your family members undergo them at the recommended intervals. 

According to Healthy People, a federal program administered by the United States Department of Health and Human Services, 

“routine cardiovascular exams alone save tens of thousands of adult lives each year.” 

Remember, early detection often leads to more successful treatment outcomes and a happier and healthier household.

5. Prioritize a Healthy Lifestyle:

Preventative care extends beyond doctor visits. Encourage your household to adopt a healthy lifestyle by emphasizing regular exercise, a balanced diet, and adequate sleep. Engage in physical activities together, prepare nutritious meals as a family, and create a conducive environment for restful sleep. 

Using the free care built into your health plan can save you hundreds down the road. Check out these 6 easy steps to using your preventive cae.

There are several ways for you to start your health journey, a local nutritionist is just one suggestion. This specialist can work with your physician and can work with you to craft a personalized health plan for you and your family based on individual needs. 

The same goes for regular exercise, you don’t have to join an expensive gym or hire a pricey trainer, although those are great options, you can start small. Ask around in your community for local meet-ups, walking/running clubs, and the like. You’d be surprised how many people are just wanting a little accountability like yourself. 

 

These lifestyle habits will significantly reduce the risk of chronic diseases and promote overall well-being for your family. 

6. Mental Health Matters:

Don't forget about the importance of mental health in preventative care. Encourage open conversations about emotions, and stress management techniques, and seek professional help when necessary. 

According to a study in Forbes Health, “In 2020…only 37.4% of males received mental health services” Life is difficult at times and we all need an outlet, we cannot let the ‘mental health’ stigma be attached to such care that so greatly impacts our daily life.

Increased stress leads to poor work performance, strained relationships, and increased health concerns. Consult with your insurance provider to see what mental health services are available under your preventative care plan.

Prioritize activities that promote relaxation, such as mindfulness exercises, hobbies, and spending quality time together as a family will help to lighten the mental load and teach better self-control when stressful situations do arise. 

By embracing preventative care services, your household can lay the foundation for a lifetime of good health and well-being. Take charge of your wellness journey by building a strong relationship with your healthcare provider, scheduling regular check-ups, staying up-to-date with vaccinations and screenings, and adopting a healthy lifestyle. 

Remember, prevention is the key to a happy and thriving household. Start today, and let preventative care be your family's guiding light toward a brighter future!

To review Meridio’s everyday health offering visit: getmeridio.com

Industry Insights
October 20, 2023
4 min. read

A Taste of the Safe Side: 5 Essential Food Safety Tips

Industry Insights

5 key tips for maintaining food safety to properly educate future generations of chefs: 

1. Hand Hygiene
Consistent handwashing is the most effective way to mitigate the transmission of foodborne pathogens. Thoroughly wash your hands with soap and warm water for at least 20 seconds before handling food and after handling raw meat, poultry, or seafood.

2. Proper Food Storage
To preserve food freshness and maintain organization, utilize a variety of wrappers and containers tailored for different items. For example, use airtight containers for grains, zipper bags for delicate fruits, and aluminum foil for leftover dishes. 

Store food at the correct temperatures to prevent bacterial growth. Refrigerate perishable items at or below 40°F (4°C) and keep frozen foods at 0°F (-18°C) or lower. As a general guideline, raw meats can be refrigerated for 1-5 days and frozen for 3-12 months, while vegetables can be refrigerated for 3-7 days and frozen for 8-12 months. Always be sure to rely on your own judgment to ensure safety and freshness. 

3. Cook to Safe Temperatures:
Quick-serve restaurants often cook poultry to 165°F (73.9°C) for rapid service, while dine-in and fine dining establishments may have more flexibility, opting for temperatures ranging from 145-165°F (62.8-73.9°C) for enhanced flavor and presentation. 

Each type of restaurant tailors its cooking temperatures to their unique needs and culinary style while prioritizing food safety. Use a food thermometer to ensure that foods are cooked to safe internal temperatures. 

USDA recommendations:

  • Poultry - 165°F (73.9°C)
  • Ground meat - 160°F (71.1°C) 
  • Whole cuts of meat 145°F (62.8°C) 

For a deeper dive into USDA's safe minimum internal temperature guidelines, you can find additional information here.

4. Avoid Cross-Contamination

Minimize the risk of cross-contamination by avoiding the transfer of harmful bacteria from one surface to another. Use separate cutting boards and containers for raw meats to avoid cross-contamination; color-coded cutting boards can help differentiate between various ingredient types. 

For instance, when preparing a meal, use one cutting board exclusively for slicing raw meats and another for chopping fresh vegetables. Have dedicated containers for marinating meats and storing leftovers. This separation ensures that harmful bacteria from raw meat don't come into contact with ready-to-eat foods, reducing the risk of foodborne illnesses.

5. Regular Cleaning and Sanitizing

This entails wiping down all areas and equipment with disinfectants, regularly replacing dish towels, and cleaning storage areas. Be particularly vigilant about frequently touched surfaces and the handles of kitchen tools.

A few key cleaning products used by chefs: 

  • Commercial Degreasers: Removes tough grease and grime from stovetops, ovens, and grills.
  • Disinfectant Cleaners & Multi-Surface Cleaners: To regularly sanitize kitchen equipment and food preparation areas; suitable for a wide range of surfaces.
  • Bleach or Peroxide-Based Cleaners: To deep clean and disinfect areas, specifically addressing bacterial contamination.
  • Sanitizing Wipes: For quick and convenient surface cleanup of countertops, equipment handles and high-touch areas.
  • Dishwashing Detergent: For cleaning and removing food residue from kitchen utensils, cookware and dishes. 

By thoroughly following food safety guidelines, you reduce the risk of foodborne illnesses. However, accidents can happen in any kitchen - That's where Meridio comes in as a vital safety net. Meridio ensures that, in the unfortunate event of an illness or injury, you have the necessary healthcare coverage that is affordable and easy to access.

Focusing on food safety extends beyond just safeguarding your customers. Ensure your own well-being as a chef by exploring Meridio's cost-effective healthcare solutions at getmeridio.com 

Industry Insights
March 24, 2023
4 min. read

What Will the Future of Work Look Like for Small Businesses?

Industry Insights

For Small Businesses What Will the Future of Work Look Like?

Will it be more remote, more diverse, and more flexible?

Nowadays, more people are choosing to work remotely, either as their primary career or as an occasional arrangement or a part time job. As technology continues to advance, this trend shows no signs of slowing down. In fact, a recent study by the *Becker Friedman Institute found that 30% of workers responded they were more productive and engaged when working from home. As technology continues to advance, this is what we can expect the future of work to look like when more employees choose to work remotely and incorporate remote working into their regular office routines and daily schedules.

Where do millennials work?

Millennials are defined as individuals born between 1981-2000 and they seem to be driving the push for remote work environments. A **recent study shows that millennials are more likely to work remotely than any other generation. A whopping 84% of millennials say remote work is important vs. 66% of Gen Z, 75% of Gen X and 68% of Boomers.

This is likely because millennials value work-life balance, and flexibility over things like prestige and salary. Benefits are also important to this generation, nearly 60% of millennials say they would switch jobs for better benefits.

With the rise of companies who are promoting remote working, people are moving away from commuting to work, along with spending hours stuck in traffic every day to get there. Remote workers can use technology to still be productive during those long commutes or periods of downtime where you can't get anything done. With so many employees looking for a good benefits package, many companies are offering flexible work schedules and telecommuting opportunities as benefits that align with this new remote-first world.

How do workers collaborate?

Due to being in the post-broadband age, access to high-speed internet has grown exponentially over the last decade, giving workers everywhere access to information and each other with few barriers. With this access comes new tools and systems like Zoom, Google Hangouts, Skype for Business, Microsoft Teams, as well as video conferencing platforms like LifeSize that make it easier for employees to connect at all hours. Remote workers can also leverage and use social media platforms like Facebook and Yammer to collaborate remotely. All these new technologies open up opportunities for greater collaboration across borders and cultures.

In 2022 there will be nearly one billion employees globally who work remotely, at least part-time and about half of all employees at small businesses, which have less than 10 employees, also work remotely at least part-time. 

These trends are becoming staples and standardizations that will lead to a world where most people in developed countries could live their lives never visiting an office again. Companies such as Google have already reached this point, for example, Google’s New York City headquarters famously houses only four percent of its workforce.

How does this benefit employers?

Remote work can benefit the employer even more than it does the employee. With employees working remotely from all over the world, employers can tap into a global talent pool that is different from what they have engaged in locally. As an Employer, offering flexibility to retain employees by giving them options around when and where they work, will result in higher quality workers, more productivity, and lower business costs. A recent study by ***Owls Lab found that on average, those who work from home are 47% more productive. In turn allowing the Employer to reach business goals quicker while spending less. 

The end of paychecks

Finally, the biggest change for the future of work could be the end of the paycheck. With remote work, fractional work, and part-time work on the rise, salaried workers could become rare. The money you make will come from a variety of sources: your company, clients, investments or some other source. You'll have to learn how to manage your finances in a way that's unfamiliar to most people today like managing variables and fixed costs. This means you're responsible for determining what's important to you financially, so you can work at it 100 percent of the time.

For business owners, this means alignment with your workforce and having more opportunities to grow your company. Even for workers without a salary, you will want to attract and retain them for a long duration. Offering low-cost employee health insurance is proven to improve fractional worker retention and Meridio makes it easy. See how easy it can be—download the Meridio overview below.

Industry Insights
January 4, 2023
5 min. read

Healthcare for Small Businesses: Understanding the Jargon

Industry Insights

One of the most important things you can do as a small business owner is protect your team by offering the right benefits at the right price. Unfortunately, this can be tricky with so many confusing insurance terms out there like ERISA, COBRA, and HIPAA that are easily misinterpreted. 

Health Insurance and You

Here are some tips on how to understand what these terms mean, whether you’re an employer or an employee.

You may be wondering if you need to provide health insurance for your team members. The answer is maybe. If you have 50 or more full-time equivalent employees, you are required to provide health insurance under the Affordable Care Act. If you have less than 50 full-time employees there are options that don’t cost you a dime but still allow you to provide your team access to the healthcare benefits that matter most. 

Health Insurance Terms

If you're a small business owner, there's a lot of terminology to know when it comes to health insurance. For example, you may have heard of HIPAA and ERISA

Here's a quick rundown of what these terms mean for your business: 

HIPAA (Health Insurance Portability and Accountability Act) is the law that gives people the right to keep their medical coverage from job to job, including when they retire or if they are out of work due to injury or illness. 

ERISA (Employee Retirement Income Security Act) is designed to provide retirement security for workers who can no longer work because of age or disability.

What is Dental Insurance?

Dental insurance is a type of health insurance that helps cover the cost of dental care. It's important to have dental insurance because it can help you pay for preventive care, like cleanings and checkups, and also for more costly procedures  like fillings, crowns, and root canals. Dental insurance is offered by employers, but you can also purchase it on your own. Each insurance plan has certain providers (dentists) in its network. In order to see one of these dentists, you will need to go through the plan before making an appointment. 

What is Vision Insurance? 

Vision insurance is a type of health insurance that covers eye health, allowing you to receive care for routine eye exams, contact lens fittings, and eyeglasses. Some coverage may include discounts for LASIK and other corrective surgeries. Similar to dental insurance, many employers offer vision insurance, although you can also purchase it on your own. Be sure to explore each vision insurance plan to see what providers are in the network and what coverage is offered. You’ll want to choose a plan that fits your vision needs. 

What is Life Insurance?

Life insurance is an insurance term that refers to the coverage that pays out a death benefit to your beneficiaries in the event of your passing. It's an important part of financial planning, especially for small business owners, as it can help ensure that your loved ones are taken care of financially if something happens to you. There are many different types of life insurance policies, so it's important to understand what they cover and which one best suits your needs.

What is Hospital Indemnity coverage? 

Hospital Indemnity insurance is a type of medical coverage that pays benefits if you are hospitalized. Regardless of your existing medical coverage, these benefits are paid to help cover costs that your primary insurance may not pay. Some examples of coverage may include fixed benefits for admission to the hospital, fixed benefits for each overnight stay, or a fixed benefit for a stay in intensive care. While you can purchase Hospital Indemnity on your own, many employers offer it as an addition to their health insurance plans. Each Hospital Indemnity plan is different, so it’s important to review your options.

How Does Short-Term Disability Work?

Short-term Disability insurance is a type of insurance that provides income replacement for a limited period of time if you are unable to work due to a covered accident or illness. The benefit period is typically 26 weeks, but can vary depending on the policy. To be eligible for benefits, you must be disabled and unable to perform the essential duties of your job. In most cases, you will need to provide medical documentation from a licensed physician to prove your disability. Short-term Disability insurance is usually offered by employers, but again can be purchased separately. 

What is Accident coverage?

Accidental insurance is a type of coverage that pays cash benefits if you sustain an unexpected accident or unexpected death. Accident insurance is usually offered to employees as an add-on to health insurance, although employees can purchase it on their own. Qualifying accidents allow you to receive cash to cover out-of-pocket expenses that your health insurance may not cover. While each Accident plan is different, many will have options to choose from that meet your personal needs. 

Understanding How to Talk to Employees.

When you're a small business owner, you wear a lot of hats. One of those hats is Benefits Administrator, and while that role comes with a lot of responsibility, it doesn't have to be complicated. 

Here are 3 tips for talking to your employees about insurance: 

1) Know the lingo. It's easy to get lost in all the words and jargon related to healthcare and life insurance; fortunately, there are definitions available online that can help guide you through what they mean when referencing terms such as deductibles, co-payments, coinsurance and more. 

2) Use charts and graphs. You don't need to make employees feel like they're sitting in an algebra class. Take the time to break down different aspects of healthcare or life insurance so people can see them visually--you'll have their attention much longer than if you just read off a list of things they should do or know. 

3) Be patient. No one likes to talk about insurance, that includes your employees. It will take time for people to understand these terms. Start by giving them basic explanations and over time, as they become comfortable with the idea of taking control of their own healthcare decisions, gradually add additional detail. Employees may still ask questions as this process unfolds but that means you're doing something right!

Offering Meridio Benefits gives you access to expert Benefits Guides at your fingertips that can help your employees learn more about your insurance offerings without any work from you. Click the button below to download our overview document and see if Meridio health benefits are right for your team.

Industry Insights
February 24, 2022
7 min. read

The Affordable Care Act: How it Affects Small Business Owners

Industry Insights

Although Obamacare has received mixed reviews, it’s clear that it has a significant impact on small business owners and their employees.

The Patient Protection and Affordable Care Act (ACA), referred to as the Affordable Care Act or “ACA” for short, was signed into law by President Barack Obama in March of 2010 and aims to extend insurance coverage to uninsured Americans and to slow the increasing costs of healthcare. 

The Affordable Care Act

“Obamacare,” as it’s most often referred to, is the most controversial and far-reaching healthcare legislation in decades. The law was designed to increase access to affordable health insurance, but it also has a number of provisions that affect small businesses. As a business owner, you need to be aware of how Obamacare will impact your company. 

Obamacare and How It Affects Small Business Owners

The ACA authorized the creation of new healthcare marketplaces, also known as exchanges, where individuals and small businesses can purchase health insurance. Businesses with 50 or more full-time or full-time equivalent (FTE) employees are required to offer affordable health insurance. 

Businesses with 1-49 full-time employees are not subject to this requirement. However, due to the expensive nature of individual healthcare products from the marketplace, small businesses need solutions to help employees.

ACA Mandates

The Affordable Care Act mandates that all businesses with 50 or more full-time or full-time equivalent (FTE) employees must provide health insurance for their employees. If a company fails to do so, they are subject to penalties. Despite this requirement, many believe the ACA does not help small business owners. Some of these individuals have argued that because of the mandate, small business owners are now paying higher premiums for less coverage, and as a result, are forced to cut back on hiring and other benefits to cover the costs.

In addition, under Obamacare, many Americans are required to purchase private health insurance if they are not covered by an employer or other government-assisted health plans such as Medicaid, Medicare, or TRICARE. The Individual Mandate applies to residents of California, Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia. 

Employer Responsibilities

Employer responsibilities under the Affordable Care Act include offering affordable, comprehensive health coverage to at least 95% of their full-time employees. Health coverage is considered “affordable” if the employee contribution for premiums is no more than 9.12% of household income in 2023 for employee-only coverage. It is “comprehensive” if it provides a minimum value of at least 60% of the total allowed cost of benefits provided by a typical employer plan and includes substantial coverage of physician and inpatient hospital services.

what you need to know about the affordable care act, aka obamacare, and what you can do today.

Federal Eligibility and Individual Enrollment Requirements

There are three key federal requirements for ACA Eligibility. These requirements apply in all 50 U.S. States. They are:

  1. Individuals must be either U.S. citizens, U.S. nationals, or non-citizens who are lawfully present in the U.S. for the entire time they plan to have health coverage;
  2. Individuals must not be currently incarcerated, and;
  3. Individuals must live in the United States and meet state-specific residency requirements for the marketplace where they wish to obtain coverage.

When an employee enrolls for a healthcare plan through the marketplace, they may be eligible to receive an advanced premium tax credit to help offset the cost of their monthly healthcare premiums. Certain household income limits must be met to qualify for the premium tax credit. Household income must be at least 100 percent and, for years other than 2021 and 2022, no more than 400 percent of the federal poverty line for family size.

Aside from income, other factors affecting the credit amount include:
  • Cost of available insurance coverage
  • Residence
  • Address
  • Family size

Open Enrollment is the period each year when individuals are allowed to enroll in or make changes to a marketplace health insurance plan. The yearly open enrollment period runs from November 1 – January 15. Outside open enrollment, an individual may still be able to enroll in marketplace coverage if they have certain life events, like getting married, having a baby, losing other health coverage, or based on their estimated household income.

Insurance Market Standards

One of the most important aspects of the ACA for small business owners is the insurance market standards that it sets. Before the ACA, insurance companies were able to discriminate against people with pre-existing conditions and charge women higher rates than men. The ACA outlaws these practices and requires insurers to provide coverage to everyone, regardless of their health status or gender. This has made it easier for small business owners to get health insurance for themselves and their employees.

Benefits

The Affordable Care Act set out to standardize small-group and individual health insurance plans by creating a colored “metal” ranking for each of three tiers or levels, with each level based on actuarial value. The colors of the tiers are bronze, silver, and gold. 

All new small group and individual health insurance plans, including plans sold in the exchange as well as plans sold in the private market, must fall into one of the metal levels (unless it’s a catastrophic plan in the individual market).

The law requires that all plans offer a minimum level of coverage starting with the bronze tier, which covers 60 percent of an individual's medical costs. Silver and gold-tiered plans are also available, which cover 70 and 80 percent of medical costs, respectively. 

Benefits under a bronze plan can be complex but essentially provide a basic amount of protection at a relatively low cost. A silver or gold plan might work better for those who have more robust coverage needs, such as for families or those with significant out-of-pocket expenses due to chronic conditions. Catastrophic plans are also available, which provide high levels of coverage in case of injury or illness but not for routine, preventive care.

Besides ACA products, other health coverage options include health savings accounts (HSA). HSAs may be a good choice for business owners and individuals because they can contribute to them on a pre-tax basis and withdraw funds from them on a tax-free basis if used for qualified medical expenses. HSAs require consumers to take responsibility for monitoring their own health care costs and providers and may be particularly beneficial for those who are self-employed.

High-Deductible Health Plans (HDHPs), Health Sharing Ministry Plans, Primary Care Memberships, and Private, Non-Marketplace Plans are all health coverage alternatives outside of the ACA. There are many options for small business owners and individuals to choose from based on personal needs and budget.

In addition, the ACA offers small business healthcare tax credits to small businesses that purchase health insurance for their employees through its Small Business Health Options Program (SHOP).

Walking you through the complexities of the Affordable Care Act and how you can save money by avoiding tax penalties.

  

Penalties for Noncompliance or Unsatisfactory Thresholds

If a business with 50 or more full-time employees fails to meet the ACA’s minimum requirements for providing health insurance to its staff, penalties may be levied. 

If an employer with 50 or more FTE employees doesn’t offer coverage to at least 95% of FTE employees, the potential penalty is $2,900 per full-time employee in 2025 (that amount started at $2,000 but has been adjusted for inflation). The first 30 employees are excluded from the calculation. For example, if an employer has 65 FTE employees, doesn’t offer any health coverage, and at least one employee gets coverage in the exchange and qualifies for a premium subsidy, the employer would owe a $101,500 penalty for 2025. The calculation is: (65-30) x 2,900 = 101,500.

On the other hand, if an employer provides a health plan, but that plan is unaffordable and/or doesn’t provide minimum value, the employer would face the lesser of two penalty options: $4,350 per employee receiving premium subsidies in the exchange (this started at $3,000 but has been indexed for inflation), or the $2,900 per full-time employee (minus the first 30) penalty as described above.

To illustrate, consider a business that has 120 full-time employees and offers coverage, but it’s either not affordable and/or doesn’t provide minimum value: If 70 employees get subsidies in the exchange in 2025, the employer would pay a penalty of $259,200 for the year ((120-30) x 2,900 = 261,000). That’s the lesser of the two penalties, with the alternative penalty calculation totaling $304,500 (70 x 4,350).

How to Navigate

As small business owners, we never expect to be faced with the number of challenges that can arise when starting a business. We want the domain and freedom to build something great. Administrating and navigating healthcare has made that unnecessarily difficult. 

The reality is that the Affordable Care Act is now law and most likely here to stay. You can get a broker to help you implement and manage health care for your workers or you can do it on your own. 

Your Health Insurance Alternative

The continued rising cost of healthcare has made it difficult for small (and medium-sized) businesses to operate, including providing healthcare. Many employers are now opting for lower-cost minimum essential care plans as a way to not only reduce their expenses but help employees do the same. 

Meridio offers a solution to the growing problem of rising healthcare costs by providing small businesses with affordable, ACA-compliant, basic health coverage plans for themselves and/or their employees. Anyone can take advantage of our guaranteed acceptance plans with licensed Benefits Guides and a Customer Care team available to assist with enrollment and offer continued support. We remove the administrative burden so that companies can offer quality healthcare without inconvenience or a lengthy process to implement.

We’re happy to answer all your questions and help you decide what’s right for you. For moreinformation you can request information here.

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eliminating unnecessary steps and confusion.
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