What is the best small business health insurance in 2026?
Five ways to cover your team, one platform per way, with the fees each one actually publishes.
You want to offer health coverage, and every option seems to need a broker, a quote and three weeks. It doesn't have to. In the US, a small employer has five real ways to cover a team, and each one can start online.
Short answer: PeopleKeep if you want the lowest fixed cost, with a QSEHRA or ICHRA at $25 per employee per month plus a $50 base fee. Justworks if you want payroll, HR and large-group plans in one bill, from $79 per employee per month. Take Command for an HRA with more hands-on help, from $25 per employee per month. SHOP Marketplace if you qualify for the tax credit. Sana for a level-funded plan that can refund unused claims money.
These are platforms and insurers, not software in the usual sense. We compared them on cost control, online setup and admin, employee choice and tax advantages, using their official pages.
Our ranking is editorial: a sponsored spot is always labeled on its card, and no affiliate link changes a score.
The best option for how you want to pay
The 5 best small business health insurance options compared
Every fee comes from the provider's official page. Premiums for the plan itself are separate unless stated. The key column: what you can do online without talking to anyone.
| Best for | What happens online | Free plan | Team size | Visit | ||||
|---|---|---|---|---|---|---|---|---|
| 1 | PeopleKeep | Best HRA for cost control | QSEHRA or ICHRA set up and run online | 4.4/5 | $25 per employee per month plus $50 base fee | — | 1 to 50 employees | Visit → |
| 2 | Justworks | Best PEO for small teams | Payroll, HR and large-group plans in one platform | 4.4/5 | PEO Basic $79, PEO Plus $124 per employee per month, premiums extra | — | Teams that want one vendor | Visit → |
| 3 | Take Command | Best HRA with guided setup | QSEHRA and ICHRA with enrollment help, no setup fees | 4.2/5 | From $25 per employee per month (1 to 49 employees) | — | Teams new to HRAs | Visit → |
| 4 | SHOP Marketplace | Best for the tax credit | Enroll direct with an insurer or a SHOP broker | 3.9/5 | Premiums by plan and area, tax credit if eligible | — | 1 to 50 employees | Visit → |
| 5 | Sana | Best level-funded plan | Level-funded plan with $0 virtual primary care | 3.6/5 | Quoted per group, fixed monthly payment | — | 2+ enrolled employees in 16 states | Visit → |
Fees per employee per month. For HRAs, the allowance you reimburse comes on top. For a PEO, insurance premiums come on top. Real premiums depend on your state, ZIP code, team ages and plan level.
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How we compared and scored
A small US employer doesn't pick an insurer first. It picks a model: an HRA, a PEO, a SHOP plan or a level-funded plan. So we ranked one strong platform per model, and scored each on what matters before you sign: what it costs you every month, how much of the setup happens online, how much choice your employees get, and the tax advantages.
We read each provider's pricing and product pages, HealthCare.gov's SHOP rules and a large number of user reviews. One value per provider across the site: every option keeps the score it has on our micro-business and SMB rankings. Not ranked: Rippling PEO, which publishes no price on its official pages, and Gravie and Sidecar Health, whose prices we couldn't read on an official page.
- Cost controlPublished fees, a predictable monthly bill, no setup charges.30 %
- Online setup and adminSign-up, enrollment and monthly admin done without a broker.25 %
- Fit for small teamsMinimum team size, state limits, participation rules.20 %
- Employee choiceWhether employees can pick their own plan and network.15 %
- Tax advantagesTax-free reimbursements, credits, deductible premiums.10 %
Our ranking is editorial: a sponsored spot is always labeled on its card, and no affiliate link changes a score.
PeopleKeep
PeopleKeep runs health reimbursement arrangements. You set a monthly allowance, your employees buy their own individual plan, and you reimburse them tax-free up to that amount. PeopleKeep handles the plan documents, the reimbursement checks and the compliance.
The pricing is the clearest in this ranking: $25 per employee per month and a $50 monthly base fee, for either a QSEHRA or an ICHRA. PeopleKeep says those two fees are the only charges on your invoice. For 8 employees, that is $250 a month in fees, or $3,000 a year, before allowances.
Why it ranks first: you decide the cost, not an insurer at renewal. If premiums jump next year, your allowance doesn't move unless you move it.
Its limits. Your employees do the shopping, and some will need help picking a plan. In some areas the individual market is thin, so check what plans exist in your employees' ZIP codes first. A QSEHRA is also capped by the IRS each year.
Tip: start with a QSEHRA if you have fewer than 50 employees and the same allowance for everyone. Move to an ICHRA if you need different amounts by employee class.
- Only two published fees
- QSEHRA and ICHRA on one platform
- You set the allowance
- ✓Predictable monthly cost
- ✓Tax-free reimbursements
- ✓No other charges on the invoice
- ✗Employees shop for their own plan
- ✗Depends on your local individual market
- ✗QSEHRA has an annual cap
The best pick when the priority is a fixed health budget you control.
Justworks
Justworks is a PEO, a professional employer organization. It co-employs your team, which lets a 5-person company buy into the large-group plans a PEO negotiates. Payroll, compliance and HR come in the same platform.
Pricing is public: PEO Basic at $79 per employee per month with no base fee, PEO Plus at $124. Insurance premiums are separate. For 8 employees on Basic, the PEO fee is $632 a month, or $7,584 a year, before premiums.
Why it scores high: one onboarding, one bill, and plan choices that a small group rarely gets alone. Setup happens online.
Its limits. You pay the PEO fee whether or not employees enroll in health benefits. And leaving a PEO means rebuilding payroll and benefits elsewhere.
Tip: compare the full yearly cost, PEO fee plus premiums, against an HRA plus your current payroll tool. The PEO wins when you also need its HR and compliance work.
- Public per-employee pricing
- Large-group plans for small teams
- Payroll and HR in the same bill
- ✓One vendor for payroll, HR and benefits
- ✓No base fee
- ✓Online setup
- ✗Fee applies on top of premiums
- ✗Hard to leave once set up
- ✗Premiums vary by state
The right pick when you want benefits and HR handled together and accept a per-employee fee for it.
Take Command
Take Command also administers HRAs, with a QSEHRA built for companies with up to 49 employees and an ICHRA for employers of any size. The difference with PeopleKeep is the support: Take Command puts more weight on helping employees find and enroll in a plan.
Its pricing page lists small employers (1 to 49 employees) from $25 per employee per month, and says there are no setup fees. Large employers get custom pricing.
Why it ranks here: same model, same entry fee as PeopleKeep, with stronger employee choice. It ranks lower because the pricing page shows starting prices, not a full fee list.
Its limits. The "+" in "$25+" means your bill can be higher depending on the product, so ask for the full quote. The same individual-market caveat applies.
Tip: ask for a written quote with every monthly fee listed before you compare it with PeopleKeep's $25 plus $50.
- QSEHRA and ICHRA
- No setup fees
- Help for employees picking a plan
- ✓Strong employee choice
- ✓Works from 1 employee
- ✓Clear entry price
- ✗Starting price only, "$25+"
- ✗Depends on the local market
- ✗Large employers on custom pricing
A good HRA pick if your team needs a hand to choose a plan.
SHOP Marketplace
SHOP is the Small Business Health Options Program on HealthCare.gov. A business generally needs 1 to 50 employees to buy SHOP insurance, and spouses and family members don't count toward eligibility.
The reason to use it is the tax credit. You may qualify for the Small Business Health Care Tax Credit if you have fewer than 25 full-time equivalent employees making an average of about $65,000 or less. SHOP is generally the only way to get that credit.
You enroll either directly with an insurance company or with a SHOP-registered agent or broker. There is no platform fee: you pay the premium.
Its limits. Plan choice depends heavily on your state, and admin is on you. It scores lower on online setup because the process runs through the insurer, not one simple dashboard.
Tip: check your eligibility for the credit before anything else. If you qualify, run the numbers on SHOP first, then compare.
- Tax credit generally only through SHOP
- No platform fee
- Direct or broker enrollment
- ✓Traditional group coverage
- ✓Credit can cut the real cost
- ✓Works from 1 employee
- ✗Plan choice varies by state
- ✗Admin stays with you
- ✗Credit limited to small, lower-paid teams
The first place to look if your team qualifies for the tax credit.
Sana
Sana is a health plan designed for small businesses. It sells level-funded plans: you pay a fixed monthly amount, and if claims come in lower, part of it can come back to you. Sana lists 1.2 million+ providers across the US and $0 virtual primary care through Sana Care.
Plans require at least 2 enrolled employees, and your group needs an office in one of the 16 states Sana lists.
Why it ranks here: a modern group plan with a predictable bill. It ranks last because there is no public price, and the state list leaves many businesses out.
Its limits. You only know the price after a quote. And everyone shares one group plan, less choice than an HRA.
Tip: ask Sana how refunds are calculated and when they are paid, then compare the worst-case yearly cost, not the refund best case.
- Level-funded with potential refunds
- $0 virtual primary care
- 1.2 million+ providers
- ✓Fixed monthly bill
- ✓Designed for small businesses
- ✓No out-of-network fees for members
- ✗No public price
- ✗16 states only
- ✗At least 2 enrolled employees
Worth a quote if you're in a covered state and want a group plan with a fixed bill.
Five ways to offer health coverage, and which fits you
The top results for this search list insurers. None explains that you choose a model first. Here is what each one means for your bill.
HRA (QSEHRA or ICHRA)
You set an allowance, employees buy their own plan, you reimburse tax-free. Fees start at $25 per employee per month on PeopleKeep and Take Command. Best when cost control comes first.
PEO
A PEO co-employs your team and opens its large-group plans. Justworks charges $79 per employee per month on Basic, premiums extra. Best when you also want payroll and HR handled.
SHOP or level-funded
SHOP is a traditional group plan with generally the only route to the tax credit. A level-funded plan like Sana's fixes the monthly bill and may refund part of it. Best when you want one group plan for everyone.
- Count your full-time equivalents and average pay to check the SHOP tax credit.
- Decide whether employees should pick their own plan (HRA) or share one group plan.
- Add the platform fee to premiums or allowances to get the yearly total.
- Check each provider's state and minimum enrollment rules.
- Ask what happens to coverage when an employee leaves.
- Get every fee in writing before you sign.
Set up small business health coverage online in six steps
Online setup is fast. Mistakes are fast too. Here is the order that avoids them.
Count your eligible employees
FirstSHOP needs 1 to 50 employees, and owners, partners and family members don't count. Sana needs at least 2 enrolled employees. A QSEHRA is for employers with fewer than 50 full-time employees.
- SHOP range
- 1 to 50 employees
Check the tax credit
MoneyFewer than 25 FTEs with average pay of about $65,000 or less may qualify. If you do, SHOP is generally the only way to claim it.
- Threshold
- Under 25 FTEs
Set a monthly budget per employee
BudgetWith an HRA, your budget is the allowance plus the fee. With a PEO, it's the premium plus $79 or $124 per employee on Justworks. Write both totals side by side.
- HRA fee
- From $25 per employee
Get written quotes
CompareAsk each provider for every monthly fee, the minimum enrollment, and the states covered. A starting price is not a quote.
- Ask for
- All fees in writing
Explain the benefit to employees
TeamAn HRA only works if employees buy a plan and submit proof. Run a short session and send a one-page summary with the allowance and the deadline.
- Deliver
- One-page summary
Connect payroll
PayrollPremium deductions and reimbursements must show up correctly in payroll. A PEO does this for you; with an HRA or SHOP, check your payroll tool's settings in the first month.
- Check
- First payroll run
Go further
These pages cover your case in detail, without repeating this one.
Owner-only, first hire, QSEHRA.
You have 11 to 250 employeesGroup health insurance for SMBsPEOs, participation, renewals.
You want a PEOBest PEO for small businessFees and services compared.
Payroll must follow benefitsPayroll software for SMBsWhere deductions live.
You need signed noticesE-signature for HRProof of delivery to each employee.
You track costs in your booksAccounting software for SMBsBenefit costs by month.
Small business health insurance · FAQ
What is the cheapest way for a small business to offer health insurance?
Usually an HRA. With a QSEHRA or ICHRA you set a monthly allowance, employees buy their own plan, and you reimburse them tax-free up to that amount. The admin fee is small: PeopleKeep charges $25 per employee per month plus a $50 monthly base fee, so a 10-person team pays $300 a month in fees before allowances.Can a business with 1 employee get group health insurance?
Through SHOP, a business generally needs 1 to 50 employees, and spouses and family members don't count toward eligibility. A solo owner with no other employees usually can't buy a SHOP plan, but can buy individual coverage on the Marketplace.Is there a tax credit for small business health insurance?
Yes, the Small Business Health Care Tax Credit. You may qualify if you have fewer than 25 full-time equivalent employees making an average of about $65,000 or less, and you buy coverage through SHOP. SHOP is generally the only way to get the credit.What is the difference between a PEO and buying insurance directly?
A PEO like Justworks co-employs your team and lets you buy into its large-group plans, bundled with payroll and HR. You pay a per-employee fee on top of premiums: $79 per employee per month on Justworks PEO Basic. Buying direct or through SHOP skips the fee but leaves admin with you.What is a level-funded health plan?
A plan where you pay a fixed monthly amount that covers expected claims, admin and stop-loss protection. If claims come in lower than expected, part of the money can come back to you. Sana sells level-funded plans to small businesses and requires at least 2 enrolled employees.Can I buy small business health insurance online without a broker?
Yes. You can enroll in a SHOP plan directly with an insurance company, set up an HRA on PeopleKeep or Take Command in a few online steps, or sign up for a PEO online. A broker is optional; if you want help, use a SHOP-registered agent or broker.How many employees must enroll in a small group plan?
It depends on the insurer and the plan type. Sana requires at least 2 enrolled employees. Traditional small group plans often set a minimum participation rate, so ask each insurer for its rule before you plan around a few opt-outs.