One of the most common questions for employers and employees alike is "Are the Small Business Bronze Plans the same as the Bronze Plans sold to individuals and families?" With respect to health benefits, the small business version of the Bronze Plan will have the same mandatory benefit requirements as Bronze Plans in the individual and family market. They will also cover the same overall percentage of medical costs for a typical population of enrollees.
The Affordable Care Act capped deductibles on small business health plans at $2,000 for individual enrollees and $4,000 for families. However, in February 2013 the Department of Health and Human Services permitted small group health insurance plans to exceed the deductible caps if it was necessary to maintain the appropriate percentage of out-of-pocket costs for enrollees. HealthPocket found the following average out-of-pocket costs for bronze plans in the small business market.
|Cost-sharing category||Average for a Bronze Plan|
|Medical deductible for individual enrollee||$4,216|
|Medical deductible for family||$8,667|
|Primary care visit||33%|
|Annual cap on out-of-pocket costs for an individual||$6,224|
|Annual cap on out-of-pocket costs for a family||$12,518|
The average deductibles for Bronze plans exceeded both the $2,000 individual and $4,000 family deductible caps. In fact, nearly all Bronze plans exceeded the deductible caps for both individuals and families.
Small business Bronze Plans are known as "group plans" since a single plan covers a collection of employees. Typically a group plan can obtain lower rates compared to an individual purchasing identical coverage. The larger the firm is, the greater its purchasing power. The Affordable Care Act requires companies employing 50 or more workers to provide health insurance to their employees or face a monetary penalty. Additionally, employee premiums cannot exceed 9.5% of household income or the employer can face penalties. For more information on small business health insurance and the Affordable Care Act, see our Small Business Health Insurance page.
1 Cost estimate assumes a 10 minute visit by an established patient to a doctor within zip code 02144. Estimate provided by FAIR Health (FairHealthConsumer.org) for CPT code 99212. Estimate obtained from web site on June 12, 2013.