Health Insurance for Small Businesses

The health insurance market in Maine offers many plan choices to businesses with 50 or fewer full-time equivalent employees.

Premiums. How will you divide the cost between you and your employees?

CoverME.gov has a tool to help compare costs when coverage is provided via a Small Group Plan, an Individual Coverage Health Reimbursement Arrangement (ICHRA), or by raising wages. A broker can help you weigh the options, and the CoverME.gov site also provides a broker locator tool.

Keep in mind that if you have fewer than 25 employees, it’s possible you could qualify for a Small Business Health Options Program , or SHOP, tax credit. Information and an application for the SHOP tax credit can be found on the Information for Small Businesses page at CoverME.gov.

The Bureau has compiled some additional resources related to Small Group premiums:

Cost Sharing. Depending on the plan, the insurance company will pay a certain amount of medical expenses and you and your employees will pay the rest. The Affordable Care Act (ACA) has created standardized levels of coverage into metal levels — Bronze, Silver, Gold and Platinum – to make comparing plans a bit easier. A recent Maine law requires health insurers to now offer standardized plans called "Clear Choice". Each Clear Choice plan design has the same cost sharing, regardless of the insurer offering the plan, allowing you to focus on benefit differences and quality.

Networks, Prescription Formularies, Exclusions and Limitations. Each plan has a network of health care providers and hospitals. Think about whether the network will adequately serve you and your employees, based on where these providers are located. Each plan also has a drug formulary that can be viewed before purchasing a plan. The formulary lists which drugs are covered and how much you and your employees will have to pay for each.

Also consider whether any procedures are excluded by the policy and whether limits exist on the number of times you or your employees can see certain providers.

Service. A company’s track record is an important consideration; a company that provides superior customer service may be worth additional cost. The Bureau’s Health, Disability and Long-Term Care Insurance Complaint Comparison (PDF) provides the rate of consumer complaints received by some of the companies selling health insurance in Maine. Other small business owners or individuals may also be able to recommend an insurance company, based on the service they’ve received.

Shop Around

You, your employees, and their covered dependents may be able to save money by shopping for certain services.

Maine law allows patients to see and compare costs before receiving certain treatments. It requires any health insurance company that offers a small group plan compatible with a Health Savings Account to create incentives for enrollees to: 

  • Comparison shop for lower-cost, high-quality healthcare providers, even those outside their network, for certain non-emergency services 
  • Incentives for choosing lower-cost providers can include cash payments, gift cards, or reductions in deductibles/copayments. Check with your insurance company to see which of these they offer. 
  • Eligible health services include the following: 
    • Physical and occupational therapy services 
    • Radiology and imaging services  
    • Laboratory services   
    • Infusion therapy services, and     
    • Other non-emergency outpatient services including colonoscopy, endoscopy, vasectomy and hysteroscopy 

Helpful Resources

See how to contact us, and read about how we can, and can't, assist you (PDF).

Find more resources at the National Association of Insurance Commissioners