When you get health insurance coverage in the Marketplace, you may be able to get lower costs on your premiums.

When you get coverage through the Marketplace, you may be able to save money on out-of-pocket-costs like deductibles, copayments, and coinsurance.

Most people get their Form 1095-A in their Marketplace account. A few may see this message:

If you were automatically enrolled in a plan for next year, you'll find an updated 2024 application in your Marketplace account. We created it using your current information and plan selection. Your coverage starts January 1.

If everyone on your application has Marketplace coverage with financial help and was determined eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP), you should take one of these steps, depending on your situation:

Tell the Health Insurance Marketplace® about changes to your income, household, or plan.

When entering your household members, add adults before adding children. If you get a message that someone you enter on your application needs to file their own application, they'll need to create their own Marketplace account to file their application.

You’ll be asked questions about you and your household. These questions may ask about your federal income tax returns.

Certain small employers—generally those with less than 50 employees that don’t offer a group health plan—can contribute to their employees’ health care costs through a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).

A QSEHRA allows small employers to provide non-taxed reimbursement of certain health care expenses, like health insurance premiums and coinsurance, to employees who maintain minimum essential coverage, including an individual Marketplace plan. In many states, QSEHRAs allow small employers to provide their employees additional plan choices without managing group health plan coverage.

Note: A QSEHRA isn’t a traditional group health plan. For small businesses interested in offering traditional group coverage, find out if SHOP is available in your state. Enrolling in SHOP is generally the only way to qualify for the Small Business Health Care Tax Credit, which can save eligible employers up to 50% of their employer contribution for 2 consecutive years.

QSEHRA contributions

With a QSEHRA, small employers can decide what they'll contribute to their employees’ health care costs, up to an annual maximum that is set by the IRS. Employees pay their provider or insurance company for their health care costs, then submit proof of payment to be reimbursed by the QSEHRA. Reimbursement is tax-free. If an employee doesn’t submit a claim, the employer keeps the money, though they may choose to roll it over from year to year while the employee is still employed by the business. Typically, QSEHRA amounts claimed by employees are paid monthly by their employer.

Generally, the QSEHRA amount you provide to your employees will affect the amount of premium tax credit your employees are eligible for with their Marketplace coverage. If you provide the QSEHRA to employees’ dependents, then it will affect the dependent’s premium tax credit eligibility, as well. They may be eligible for some or no tax credit depending on the QSEHRA amount you provide. Visit the IRS website to find out more about QSEHRA rules.

How to start a QSEHRA

Small employers can set up a QSEHRA at any time. To provide a QSEHRA you’ll need to give written notice to your new employees as soon as they’re eligible to participate and 90 days before the beginning of each plan year for current employees. This notice is required to include certain information–to learn more about what this notice must include, review IRS Notice 2017-67 (PDF, 211 KB). Note: Employees must have qualifying health coverage to use their QSEHRA amount.

You may want to consider how your employees can get qualifying health coverage when picking a start date. For example, providing a QSEHRA starting on January 1 allows employees to choose coverage during the individual market’s annual Open Enrollment Period, and in most cases, plan deductibles reset on January 1 each year. If you’re newly providing a QSEHRA, your employees may qualify for a Special Enrollment Period. Newly hired employees who gain access to the QSEHRA may also qualify for a Special Enrollment Period to enroll in or change individual health insurance coverage outside of Open Enrollment. To enroll in coverage through this Special Enrollment Period, employees can submit an application on HealthCare.gov and include information about when their HRA can start.

Get help: Talk to a licensed tax professional, benefits specialist, or health insurance agent/broker to find out if group coverage or QSEHRAs are right for your small business.

Exploring coverage options?

Compare QSEHRAs to other products and services that may be available to help you cover your employees.

Take me to the HRA decision guide

Employees: Understanding QSEHRAs

If you’re an employee who has been provided a QSEHRA by your employer, learn more about QSEHRAs and the Marketplace.

• Determine your next steps with help from our HRA affordability tool
• Use this worksheet to help determine if your QSEHRA offer is affordable (PDF, 147 KB)

Wondering if traditional group coverage—like a plan offered through the Small Business Health Options Program (SHOP)—or a Health Reimbursement Arrangement (HRA) is right for your small business? Understanding eligibility requirements, coverage options, and costs can help you decide which option fits the needs of your small business and employees.

The difference between certain types of HRAs and traditional group coverage

What's an excepted benefit HRA?

If you offer group coverage, you may be able to help reimburse your employees for certain health benefits up to an annual maximum of $1,950 in 2023 (adjusted annually for inflation), like vision or dental coverage, coinsurance and copayments for individual coverage, short-term health insurance, or other health care costs. This type of HRA isn’t allowed to reimburse premiums for individual coverage, traditional group health plans (other than COBRA or other continuation coverage), or Medicare. Review frequently asked questions about HRAs for individual coverage and excepted benefits (PDF, 408 KB).

Employees: Understanding HRAs

• QSEHRA
• Individual coverage HRA
• Determine your next steps with help from the HRA affordability tool

You can work with a Small Business Health Options Program (SHOP)-registered agent or broker to enroll in SHOP insurance.

Need a SHOP-registered agent or broker?

Enter your ZIP code to find one in your area.

Getting help from an agent or broker

SHOP-registered agents and brokers can provide help with SHOP insurance — from comparing plans to helping you enroll. Specifically, they can help you:

• Determine if your business is eligible for SHOP insurance
• Understand the Small Business Health Care Tax Credit
• Apply for SHOP coverage
• Review and compare plans and features
• Help employees learn about your coverage offer
• Enroll in a plan
• Manage and update your coverage after you’re enrolled
• Handle renewals and plan changes

In general, you won't pay more if you use an agent or broker.

Note: If you're not using an agent or broker, you can enroll through your insurance company.

Choosing an agent or broker

• Work with your current agent or broker: You can continue working with your agent or broker as long as they're registered with SHOP.
• Find a new agent or broker: Enter your ZIP code and check the box for small businesses, and you’ll get a list of SHOP-registered agents and brokers in your area. You can also enter your contact information on the Help On Demand tool and an agent or broker will reach out to you.

Questions?

• Review all SHOP tools, calculators, fact sheets, how-to guides, videos, and other resources for employers.
• Contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).

Learn the special rules that apply to health care options if incarcerated

To learn if you qualify for savings on health care coverage costs, select your household size and estimated income.