Nebraska Small Business Health Insurance Options
The Complete Nebraska Small Business Health Insurance Guide (2025 Edition)
HSA-for-America Complete Health Plan for Nebraska’s Small Businesses. This guide is designed for companies with 30 workers or fewer based in Nebraska.
This guide is designed to provide small business owners and professionals with the information they need in order to offer their employees health insurance that’s cost-effective. This will allow you to remain competitive and offer the compensation and benefits you need in order to keep your best talent.
Nebraska Small Business Health Insurance Benefits Options
Nebraskans have several choices when it comes time to provide health coverage to employees.
Implementing a conventional group health care insurance plan is by far and away the most affordable option.
The cost of group health insurance sponsored by employers for a family and worker varies depending on age. According to from the Kaiser Family Foundation the average annual price in 2022 will be $21,685, which is about $300 higher than the national average.
Out of that, Nebraska employees typically contribute more than $7,230, about $1,050 over the average, toward their health insurance costs.
Nebraska companies have many other options that could reduce their cost. These options include:
- Health savings Accounts (HSAs)
- HRAs are health reimbursement plans
- Direct Primary Care (DPC), memberships
- Programs for health sharing
The size of the business and your budget are important factors to consider. Also, you should take into account your workers’ age and health requirements.
Read on the go, download our Complete Guide To Small Business Healthcare Plans.
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Nebraska Small Business Health Insurance: Geographical Considerations
Nebraska has a unique healthcare system that includes not only the busy urban areas like Kearney and Lincoln, but also more rural places around Seward and David City.
Nebraska businesses should carefully consider the distribution of their staff throughout the entire state. When executives at the company’s headquarters in Omaha choose an HMO, which limits workers to in-network physicians and restricts their family members to in-network care, it is not a good idea for them to do so when many employees in Fort Calhoun live and work far from that network.
Nebraska Small Business Group Health Insurance
Most Nebraskan employers choose traditional group health insurance.
It’s also more expensive.
How’s the system works:
Third-party health insurers, which are usually for-profit corporations, provide benefits to employees as well as their families if they so desire.
Employers with more than 50 employees have to provide ACA-qualified insurance plans for employees working over 30 hours a week or face a financial penalty.
This means that the health insurance policy must cover the ten essential minimum coverages (MECs) as stipulated by the Affordable Care Act. This includes:
- Patients can receive ambulatory services without needing to go into hospital.
- Emergency Services
- Hospitalization can include overnight hospitalizations and surgery.
- The care of newborns, pregnant women, and mothers (both before and afterwards)
- Treatment for substance abuse disorders, mental illness, and behavioral problems (including counseling and therapy)
- Prescription drugs
- The Rehabilitation and habilitative Services and Devices (services and equipment to assist people with disabilities or injuries gain mental and physical abilities)
- Laboratory services
- Chronic disease management and prevention services
- Adult dental coverage and adult vision insurance are not considered essential health benefits.
The ACA also requires that health insurance cover birth control and breast-feeding.
Traditional health insurance for business is expensive, but it has the benefit of guaranteed enrollment.
The insurance company can’t deny coverage or raise the premiums if the employee enrolls in the initial enrollment phase when they qualify, during the special enrollment periods triggered by qualifying events, or at the open enrollment beginning on November 1st each year.
Nebraska Small Businesses Can Opt Out of Health Insurance
The Affordable Care Act does not require employers to provide health insurance for employees with less than fifty.
Nebraska’s state law also does not require health insurance. There is no requirement to offer insurance for employees under 50.
No penalty will be charged.
Employers of all sizes should consider offering health benefits. That includes very small firms, because they may find it difficult to hire and retain employees who are qualified without such a benefit.
Nebraska, in particular, is known for its low rates of unemployment and the fierce competition that employers have to hire talented employees.
Nebraska employers have the potential to save lots of money through a Medical Cost Sharing or Health Share Plan (see below for more information) by paying some, or all of their employees’ costs.
HRA Alternative to Nebraska Small Business Health Insurance
You can also offer your employees a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) that allows them to pay their individual health insurance tax free.
Employers can benefit from QSEHRAs in the following ways:
1.) Contribution limits are not applicable
QSEHRAs don’t require a set minimum annual contribution, unlike pension plans. You can set up your budget and adjust it each year based on your cash flow.
You can control your budget for health care benefits with a QSEHRA.
2.) Flexibility
Employees can be offered a different benefit based on whether they are married or have children. You can therefore discriminate against employees without dependents by offering a higher benefit to those with families.
3.) Employees and employers are both eligible to receive tax-free treatment.
Employer contributions are fully deductible by the IRS as compensation costs. As opposed to cash benefits, QSEHRAs are tax-free for employees who maintain health plans that include the 10 Minimum Essential Coverages specified by the Affordable Care Act.
A QSEHRA offers a more attractive alternative to a health insurance reimbursement that can be used by employees for their health insurance and other costs.
4.) QSEHRAs Encourage Employee Choice
A large number of traditional group health care plans restrict employees from a wide range of backgrounds to only one or two options.
They are usually overpriced, and not suitable for employees, because HR and management choose them, and not the workers.
QSEHRA offers workers and families a wide range of options and gives them the power to select a health plan which is right for them.
Nebraska Small Business Health Insurance Coverage Is Taxed
Both Nebraska and federal laws permit you to fully deduct your health insurance premiums as a business cost. Employees do not pay taxes on them.
The overall cost of health-sharing plans is lower. Employees can deduct the monthly costs. Employer assistance in paying for health-sharing costs is taxable.
Nebraska Small Business Health Insurance: The Disadvantages
Both employers and workers have important advantages to traditional employer group health coverage
- Cost
The monthly costs of health insurance are staggering, as we have mentioned above.
Overkill is a major factor in the high cost of traditional health insurance. Washington and Lincoln government officials have mandated coverages and requirements for health insurance that don’t make sense to many employees.
Traditional health plans, for instance, require that the carriers price mental health benefits, drug and liquor addictions, as well as maternity coverage, even though many employees don’t want or need them.
It makes them less efficient and more expensive than they should be
- Inflexibility
Group health insurance plans often offer a “one-size fits all” strategy, which may not adequately address the needs of specific employees and their budgets. By nature, group health plans sponsored by employers tend to provide only one or two options that are not optimal for certain employees.
Some workers may find it more cost-effective to purchase their own health insurance plan through the private market, taking advantage of subsidies under the Affordable Care Act.
A less expensive plan of health sharing, as discussed in the following paragraphs, may suit them better. The innovative, affordable and flexible alternatives to traditional health insurance are a good solution for employees who do not have pre-existing health conditions.
Below, we discuss health sharing plans in greater detail.
- Administrative burden
Administrative costs are high when managing a comprehensive health plan. It involves managing documents and compliance, auditing the plans to make sure employees are not enrolling non-qualified individuals into the plan and answering questions from staff. This is essential for a health insurance plan to run smoothly within an organization.
They are a burden for very small companies who do not have enough employees to support a full time HR team to manage the plan.
Some business owners use other strategies, such as the Health Care Stipends or Reimbursement Arrangements.
This alternative approach encourages workers to obtain their own insurance through Affordable Care Law. Workers may then be able to take advantage of available subsidies. It removes employers from the process and reduces administrative and overhead costs.
Health Sharing Plans in Nebraska
Small businesses in Nebraska can benefit from health sharing plans as an affordable and viable alternative to expensive insurance.
Nebraskan businesses increasingly use medical cost sharing as an affordable alternative to traditional group insurance plans. Health sharing is a great way for companies to save money on their premiums.
Nebraska small business could save as much as $10,000 per annum per employee, for a family plan, or $3,500 annually for a single policy.
These programs offer a modern way of funding healthcare. Companies can provide their employees with access to high quality healthcare and still control costs. Shared resources are the basis of health-sharing programs.
The participants of health sharing programs make a certain amount of money each year, instead of the usual insurance that involves payment of premiums.
Health Sharing Plans vs. Health Insurance
The health sharing plan is not the same as the insurance.
Healthsharing groups are associations made up of people with similar interests who share medical costs. Health sharing organizations are not-for-profit, unlike health insurance companies.
Mandatory Coverage
Health Insurance Plans do not require coverage of many items that are required by federal or state laws. Health sharing organisations are exempt from the requirements for minimum coverage.
It is not necessary for medical cost-sharing to cover addiction treatment costs for individuals who have never used drugs. Also, they do not need to cover any injuries caused by a member’s drunk driving.
Prior Existing Conditions
Unlike health insurance, some healthsharing plans impose a period of waiting before they share costs for treating pre-existing health conditions.
The waiting periods are often longer for certain surgeries. However, this is only applicable to accidents and injury that the members could not have anticipated before enrolling.
They also help to reduce adverse selection. These waiting periods are a good way for health sharing organizations to provide a comprehensive set of benefits that costs a small fraction of a policy purchased on the Healthcare.gov Nebraska online exchange or a policy not subsidized under the ACA.
Under the Affordable Healthcare Act, healthsharing doesn’t qualify to receive subsidies. Although the cost savings can be so large, many people are still able to benefit by changing from healthsharing plans, even if, depending on circumstances, they may qualify for subsidy.
Nebraska employers may find that switching to a health-sharing plan makes more sense, since small group plans do not qualify for ACA’s premium tax credit.
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Nebraska Health Sharing and Network Restrictions
Health-sharing plans are often more flexible when it comes time to choose healthcare providers.
Nebraska health sharing organizations do not usually restrict the patients’ choice to network providers. In most cases, members of health sharing plans are free to select any provider or doctor. People are given the choice to choose their own doctors.
Do You Need Health Insurance for Your Employees?
Every company is different. The best plan to use, be it a group health plan with a healthsharing model or the traditional plan that includes health insurance, requires careful evaluation.
You can get full analysis and specific recommendations for your business and staff in Nebraska.
To begin the process, click on this link for an appointment.
Prepare an employee census.
In most cases, switching employees to health coverage can result in savings up to thousands. It may not make sense to share health insurance with workers who already have preexisting conditions.
Free consultations and analyses are available.
Health Reimbursement Arrangements for Nebraska Small Business Health Insurance
The Health Reimbursement Arrangements, or HRAs as they are also known, is a benefit funded by the employer that allows employees to receive tax-free reimbursement for healthcare expenses.
Nebraskan small businesses often do away with the benefit of group health insurance. They establish a HRA instead, which they use to give employees the money needed to pay for their health insurance with pretax dollars.
Workers can then take advantage of the subsidies available, which further reduces the cost to the company.
Employees can access their HRA benefits if any money remains after they pay the premium. This includes deductibles for prescription drugs, copays (amounts paid by employees), and durable medical items. HRA benefits, once again, are not taxed to employees.
By offering an HRA instead of a group insurance plan that is formal, you give your employees the freedom to select health plans that meet their preferences and needs.
Click on this for more information about HRAs in small business.
QSEHRAs: The HRA for Nebraska Small Business Health Insurance
QSEHRA or Qualified Small Employee Health Reimbursement Agreement (pronounced “Cue Sarah”) is the special HRA type that small businesses can utilize.
This benefit is intended for businesses with fewer 50 full-time staff or its equivalent.
The QSEHRA allows businesses to choose their maximum QSEHRA contribution, subject to certain restrictions. Nebraska employers may contribute $5,850 to individual employees up to $487.50 each month and $11,800 to employees with families up to $983.33.
The employees use this money to buy their own health insurance through the online exchange or via a Personal Benefits Manager on the market for individual and family insurance. The employee retains the right to a subsidy that they wouldn’t get from a group insurance plan paid by their employer.
Employers can reimburse their employees either for the premiums alone or for both premiums and additional medical expenses.
QSEHRAs (Qualified Special Enrollment Health Savings Accounts) and Special Periods of Enrollment
You will have to offer your workers a Special Registration Period if your HRA replaces your old health insurance. This window allows employees to choose their own ACA insurance with guaranteed-issue rights without having medical underwriting.
If you choose to switch from a group health care plan entirely to a QSEHRA, your employees will not be affected by the change.
Advantages of HRAs
Health Reimbursement Arrangements, or HRAs, have many benefits. Tax-deductible for you as well as free of tax to employees, the HRA money spent by your company on employee benefits will be a tax deduction.
HRA is your money, and you retain it until the funds are distributed to workers. This money remains in your account as an operating capital. No third parties are required.
The HRA benefit can be designed by employers in a way that suits their needs, and includes what costs you’re willing to cover.
The workers’ health coverage is not affected if they change their status to contractor or leave the organization. The QSEHRA allows the employee to control and own their insurance. The employee, not the employer.
HRA Disadvantages
Many workers do not wish to take on the task of researching and selecting their own healthcare plan. Some workers need assistance to make the switch.
We can help if you are in this situation. There is no one left behind.
Have your workers call 800-913-0172 or simply click on this link for an appointment to receive personalized and individual service.
Click on here to find out more about the alternatives to health insurance offered by employers for Nebraskan small businesses.
Direct Primary Care: The Advantage
Direct Primary Care plans are a new alternative health care model gaining popularity across Nebraska.
Membership-based: For a monthly flat fee that is affordable, similar to a gym subscription, you can provide your employees with as many appointments as needed, in person or by telehealth.
DPC memberships start as low as $80.00 per month, making it a very affordable and attractive option to improve your health.
DPC offers members access to all routine, primary, preventive and chronic health care services.
Examples of primary care direct services provided include:
Here is a list of some common services provided by primary care physicians:
- Preventive care. DPC physicians emphasize prevention medicine, providing services like routine checks-ups and immunizations as well as screenings and tests for different conditions.
- DPC’s doctors provide acute care for minor injuries, infections, illnesses, such as the flu and cold, minor skin disorders, and other injuries.
- Chronic disease management. DPC doctors assist patients in managing chronic conditions such as hypertension, diabetes, arthritis and more. These doctors offer ongoing treatment, monitor patients, and adjust their plans of care as required.
- Comprehensive physical exams. DPC offers comprehensive physical examinations that allow doctors to determine your health status, assess potential health problems, and make personalized recommendations.
- Urgent care. DPC Doctors are usually available the same or next day for urgent care. To ensure that patients receive timely attention, they can make appointments for any non-emergency health issues.
- Lab and Diagnostic Services DPCs may perform or arrange a range of lab tests including blood work, urine testing, X-rays and ultrasounds as well as electrocardiograms.
- Medicine management. DPC physicians can prescribe medications and monitor their efficacy, making adjustments as required. Also, they provide counseling and education about medication use.
- Mental health service. DPC practices often include mental healthcare services in their overall care. DPC practitioners may refer their patients to mental health professionals for counseling and therapy.
- Minor Procedures. DPC doctors can perform some minor procedures at their offices, including suturing wounds, skin lesion removal, injections of joints, etc.
- Referrals, coordination of services and care. DPC’s doctors coordinate and advocate for their patients, working with specialist hospitals, clinics, and other health providers to refer them when they are required.
There are also no copays or coinsurances because there isn’t an insurance company. Monthly subscriptions cover everything. It allows workers who are strapped for cash to receive the medical care they need immediately. Patients no longer need to postpone their doctor’s appointments because of a high deductible or copay.
Patients can select supplemental plans to cover additional services, such as accident insurance, high-deductible health plans or health sharing plans. DPC members can choose to cover routine health care at a lower cost by opting for health sharing instead of traditional insurance.
Accounts for Health Savings (HSAs)
The HSA (Health Savings accounts) is a powerful tool that can assist workers in managing their health care costs and also help to keep the premiums of workplace health insurance lower.
Nebraskans need tax relief. Businesses and residents in Nebraska are no exception. Good news! Employer contributions into employees’ Health Savings Accounts can be fully deducted from Nebraska corporate tax.
HSAs enable individuals to pre-pay for future healthcare costs. HSAs can be funded by employees as well as employers. However, the annual contribution limit is set each year by Congress to match inflation.
Money in an HSA enjoys tax-deferred growth, and withdrawals to pay for qualified healthcare expenses is tax free.
HSA Eligibility
To be eligible to contribute to or receive employer pretax contributions into an HSA, the employee must have a qualified high-deductible health plan.
According to the IRS, a high deductible plan is one that has a deductible at least of $3,000 or $1500 for individuals.
A HDHP can only have a maximum of $7,500 in annual out-of-pocket expenditures (including copayments, deductibles, and coinsurance). This limit is higher for families. It does not include out-off network services. ).
Do I have to choose between HSAs and Health Sharing?
There is only one major plan available to employees that preserves their eligibility for contributions pre-tax into an HSA: HSA’s SECURE Plan.
HSA SECURE Plan offers a great way to combine tax advantages and savings on healthcare with healthsharing.
Your employees will need to have income from a small business or self-employment in order for them to be eligible.
HSA SECURE plans are not offered to employees who receive a W-2. HSA Secure is available to employees who are self-employed, have side businesses, do freelance work, or own a business. If they’re in good health and don’t need any ongoing medical care due to preexisting conditions, this plan may be the best option.
The HSA SECURE plan is also a good option to save money for both you and your business partners.
You would need to have your employees enroll themselves in HSA SECURE. Once they have enrolled in an HSA and set it up, you may make contributions pre-tax on their behalf.
How Are Nebraska Small Business Health Insurance Benefits Taxed?
You now know about the different strategies that small businesses can use to supplement traditional health coverage. Below is a quick table describing how taxation works for each benefit.
| Plan Type | Employer | Workers |
|---|---|---|
| Traditional health insurance premiums | Tax deductible. May qualify for a tax credit (see below) | Non-taxable |
| HSA contributions | Tax deductible | Pre-tax, up to certain limits. No income limitations. |
| Health sharing costs | Tax deductible as a compensation expense | Taxable as ordinary W-2 income |
| Health reimbursement arrangements | Tax deductible | Benefits are non-taxable to the employee |
| HSA withdrawals | N/A | Withdrawals for qualified medical expenses are tax-free. Otherwise taxable as ordinary income. A 20% penalty for non-qualified withdrawals applies up until age 65. |
| Direct primary care costs | Tax deductible as a compensation expense | Taxable to the employee |
Nebraska Small Business Health Insurance Care Pyramid: Addressing All Levels
As shown in the below diagram, a good package of employee benefits should cover all the levels of the Employee Healthcare Pyramid, from preventative care to primary care for early detection and maintenance of health issues, up until catastrophic events.
On the left, you will find a list of common solutions based on traditional insurance that can be used to address the different levels of the Care Pyramid.
While on the right, you will find a list of more affordable alternatives to offer meaningful protection at every level of Pyramid.
Plan design that is good will offer employees affordable solutions on each of these levels. The plan should ensure that none of the employees are forced to postpone or skip care simply because they don’t want to pay a higher premium or for coinsurance.
The Personal Benefits Coordinator can create for you a unique plan which provides solutions to each of the levels of the Care Pyramid. This is often done at a fractional cost compared to a conventional group plan.
Nebraska Small Business Health Insurance Tax Credit
Small Business Health Care Tax Credit, passed with the ACA allows certain small businesses claim a federal credit up to 50% on their employees’ health insurance costs.
The program was designed for businesses that have no more than 25 employees, and those who hire low-wage employees.
Both for-profits and non-profits can generally claim this credit.
* You have fewer that 25 employees, and the average salary is around $53,000. (The salaries of owners are excluded). When calculating average salaries and the number employees, the owner is generally excluded. The total number is calculated using “fulltime equivalents (FTEs)”. It means that 2 half-time employees are equal to 1 full-time employee.
* Employers must cover at least half their premiums.
* Offer coverage that meets the requirements of the Affordable Care act on the exchange state (in Nebraska) or healthcare.gov, which is the federal online marketplace for insurance.
Tax credits are eliminated when employers reach 25 employees or when the average annual salary is at least $53,000.
What is the process for claiming credit?
This tax credit can be claimed on your income tax returns with IRS Form 8941 attached (tax-exempt businesses are required to submit a Form990-T to make a claim even though they do not have to).
Contributions to health insurance for your employees do not attract tax.
What if my business does not owe any tax this year? Do I have to pay taxes?
Yes. You can carry back the tax credit to use it to offset the income tax liability for the year before or you can carry forward the tax credit to use it to offset the liability over the following 20 years.
This credit is refundable for businesses that are exempted from paying taxes.
To learn all about the Small Business Health Care Tax Credit consult your tax professional.
Combine Nebraska Small Business Health Insurance Strategies
When it comes to maximizing your coverage, combining different programs is a wise move.
Many employers have found that they can reduce their costs by offering a combination of different healthcare plans, and still provide coverage to every employee.
You could combine Direct Primary Care Plans (DPCs), for the normal care of primary patients, with health plans that are low-cost and cover catastrophes.
Comparing this to the conventional health care insurance for groups, it can save money for you, your employees or both.
If you give employees the option to sign up for an HDHP that qualifies for an HSA, or purchase an individual plan of health insurance, they can have more choice and potentially lower costs.
What To Do Now
The best course of action is to put together an employee census and contact us for a free, complementary business health plan analysis and recommendation.
A Persona Benefits manager from HSA for America will be assigned to you. This persona benefits manager will talk to you about your staff and their families, discuss your needs and budget with you, assess your employee’s ability to pay, and consider any preexisting medical conditions.
Many of PBMs were successful business owners or entrepreneurs themselves. These PBMs are business owners themselves and have a deep understanding of your requirements as an entrepreneur.
Can I provide both Health Insurance and Health Sharing at the same?
If you offer both, employees can choose the one that suits them best.
Please note, if you lose too many employees from a Group Health Insurance Plan, the Minimum Participation Rate required to continue a Group plan could be violated. HRA’s allow you to reimburse employee costs for personal health insurance.
Nebraska Small Business Health Insurance FAQs
The difference between Health Sharing and Insurance for Small Business
While health sharing refers to members sharing funds in order to cover medical expenses, traditional insurance plans are offered by insurers.
What are the waiting periods on pre-existing condition plans?
There may be a waiting period for certain health sharing plans before the coverage is provided. You should review plan guidelines or speak to a Personal Benefits manager for additional information.
In Nebraska, can employers make contributions to the HSAs of their employees?
Employers can contribute to HSAs of their employees, but only up to the annual limit set by Congress.
Nebraska allows employers to deduct contributions made by them towards HSAs when calculating state income tax?
Yes. Nebraska tax law allows for the full deduction of employer contributions made to HSAs.
What are the requirements for claiming the Small Business Health Care Tax Credits?
Businesses that make a profit may claim the tax credits on IRS Forms 8941, while businesses exempt from tax must use Forms 998-T.
HSA for America cannot provide you with tax advice. Employers can consult their own tax advisors for more details about how to apply.
A business can still claim the Small Business Health Care Tax Credit, even if it does not owe Nebraska taxes.
What is HRA and what does it do?
HRAs, or Health Reimbursement Accounts (HRAs), are funded by employers and reimburse employees who have qualified medical costs that their insurance does not cover. Employers contribute to the account based on what expenses they determine are eligible.
How do I know which health insurance options and cost-sharing plans are best for my Nebraska small business?
You don’t have to do it all by yourself. Consult a Personal benefits manager to conduct an analysis and make recommendations that are based upon your needs, budget, employee counts, and pre-existing medical conditions. A Personal Benefits manager can assist in designing a customized plan for you that will maximize the benefits to your employees, while reducing costs and keeping them competitive.
What are the benefits of Health Savings Accounts for Nebraska employees?
HSAs are a way for individuals to put money aside before taxes to pay future medical expenses. Employees and employers can both contribute to HSAs, allowing for tax benefits and savings on future healthcare costs.
What are the benefits of offering Direct Primary Care Plans (DPCs) alongside other plans for Nebraska’s small business?
Combining DPC coverage with other low-cost plans, such as Health Sharing Plans, can offer comprehensive and cost effective healthcare solutions to small businesses.
Does a small business that does not have any tax obligations in Nebraska still qualify for the Small Business Health Care Tax Credits?
Even if the business does not owe any taxes for a given year, it can still carry back the Small Business Health Care Tax Credit to offset the income tax liability of the previous year.
Does Nebraska cover the cost of maternity care under health sharing plans?
Nebraska provides maternity insurance benefits that cover prenatal care, labour, and even postnatal care. Nevertheless, there may be restrictions in some health sharing policies on costs shared for children not born through marriage.
Do HRAs work with individual and health insurance plans as well as other health coverage plans?
Yes. HRAs may be combined with other options of coverage. HRAs are used by some small companies to reimburse their employees for the premiums of individual health policies. HRA money can’t be used for reimbursements to employees.
What is the maximum size small businesses that can apply for these programs?
QSEHRA is available only to small employers (less than 50 employees). There are also other HRAs that you may be eligible for if your company has more than 50 workers or if it grows.
This ACA mandate will force you to have a qualified insurance plan in place for all your employees. If not, you may be subject to a penalty. Consult your Personal Benefits Specialist if, within the next year, you will be hiring the 50th worker full-time or its equivalent. The plan that you design could change.
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