Offering health benefits helps recruit and retain talent, reduces turnover, and can be tax-advantaged. For employees, coverage lowers out-of-pocket costs for preventive care and emergencies.

The challenge for owners is matching plan design, network access, and price to a real-world budget without overwhelming admin work.

How it works

Group health coverage is typically employer-sponsored and cost-shared. If you have at least one full-time employee who isn’t a spouse or family member, you can buy a small-group plan. Most states require that a minimum share of eligible staff enroll. You can shop direct, through brokers, or via the federal SHOP marketplace.

UnitedHealthcare

A broad national network and deep digital tools make UnitedHealthcare a versatile choice. It offers HMO, PPO, EPO, and POS options, virtual therapy access, and convenient app features for claims and care navigation. Downsides include the absence of some top-tier “platinum” designs and mixed past headlines—making local feedback and plan documents essential reading.

Blue Cross

Blue Cross Blue Shield is a federation of regional companies with extensive provider acceptance. That scale often means easy in-network access and strong wellness offerings. Because plans are issued locally, pricing, service, and benefits vary by state. In many regions, premiums and deductibles trend higher than comparable competitors, so verify the specifics before committing.

Elevance

Formerly Anthem, Elevance operates in select states and is known for wide networks and competitive quotes in those markets. It offers multiple plan types and cost tiers, which can help fit a tight budget. Service experiences are mixed across subsidiaries, and availability is limited; review the local entity’s complaint history and contract terms.

Aetna

Aetna leans into preventive care and value-based designs, encouraging healthy habits to manage long-term costs. Owners appreciate its user-friendly site, solid plan menu, and generally reasonable pricing. Be aware of above-average complaint ratios in some states and scrutinize exclusions and prior-authorization rules to avoid surprises on medical necessity decisions.

Kaiser

Kaiser Permanente pairs insurance with its own integrated care system. Members typically get strong preventive programs and competitive pricing, especially on HMO tiers. The tradeoff: limited geography and a closed network. If your team needs broad out-of-network flexibility or you hire beyond Kaiser regions, consider a different carrier or a dual-option strategy.

Humana

Humana offers customizable packages and a full slate of add-ons (dental, vision, hearing), plus generally low complaint volumes. It operates in many states and is well-rated for overall coverage quality. Premiums can land above market averages in some areas, so weigh richer benefits against payroll impact and employee affordability.

Cigna

Cigna earns points for 24/7 support and access to wellness programs, with PPO, HMO, and open-access designs. It maintains a large national and international provider footprint. Premiums may be higher, and availability is limited to certain states. Carefully compare total employee cost sharing, especially if your team uses frequent specialist care.

Plan types

HMO requires a primary care physician and referrals; costs are usually lower but networks are tighter. EPO drops referrals but still restricts to in-network care except emergencies. PPO allows in- and out-of-network use at different cost levels. POS blends HMO structure with limited out-of-network coverage. Choose based on your team’s provider habits.

Metal tiers

Most carriers offer bronze, silver, gold, and platinum tiers. Bronze has lower premiums but higher deductibles; platinum flips that equation. If your workforce is younger and price-sensitive, bronze or silver can fit. Teams with ongoing conditions may benefit from gold or platinum’s lower out-of-pocket costs, even with higher monthly premiums.

Key costs

Premiums are the monthly price. Deductibles are what members pay before the plan shares costs. Coinsurance splits costs after the deductible; copays are flat fees for specific services. Some owners contribute 50% to 70% of premiums to remain competitive. Model total cost of care—not just premiums—when comparing carriers and tiers.

Louise Norris, a health policy analyst, writes that most small-group plans require employers to cover at least half of enrolled employees’ premiums.

Networks matter

Confirm your employees’ preferred primary care doctors, hospitals, and specialists are in-network. Carriers negotiate different rates with providers; a strong network reduces balance-billing risk and travel time. Multi-site or remote teams may need a national PPO, while local teams may get better value from an HMO or EPO.

Admin and extras

Evaluate onboarding support, billing simplicity, and digital tools (ID cards, telehealth, claims tracking). Popular add-ons include dental, vision, employee assistance programs, and health savings account (HSA) compatibility for high-deductible plans. Wellness incentives can lower claims over time—but only if employees actually engage with them.

How to choose

Survey staff about must-have providers and budget comfort. Set an employer contribution strategy that’s sustainable. Shortlist two carriers and two metal tiers, then run side-by-side scenarios using identical assumptions (age mix, dependents, zip codes). If feasible, offer a dual-option lineup to accommodate different needs without overcomplicating administration.

Bottom line

There’s no one “best” insurer for every small business. UnitedHealthcare and Blue Cross offer breadth, Kaiser shines where available, and Aetna, Humana, Cigna, and Elevance each bring distinct strengths. The right pick is the one that matches your team’s providers, your affordability targets, and the day-to-day experience you want employees to have.