Missouri Small Business Health Insurance – 2024 Guide

Missouri Small Business Health Insurance

Traditional employer-sponsored health insurance is expensive, especially in Missouri. Fortunately, small businesses have multiple cost-saving alternatives to explore. This guide outlines those options and critical considerations for Missouri business owners.

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Options Beyond Traditional Insurance

Critical Factors for Small Business Health Insurance in Missouri

  • Size: Laws and ideal options vary based on your employee count.
  • Budget: Alternatives can offer significant cost savings.
  • Employee Needs: Consider the range of health needs within your workforce.
  • Geography: Healthcare access varies within Missouri (urban vs. rural) – factor this into your plan choice.

Traditional Insurance: Still a Viable Option

  • Pros: Comprehensive coverage, ACA mandates essential services.
  • Cons: Often the most expensive choice.
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Understanding Missouri and ACA Laws

  • Employers with under 50 employees are NOT mandated to offer insurance.
  • Consider HRAs & Individual Coverage: Employees may qualify for ACA subsidies.
  • Pairing Options: DPC + health sharing or DPC + HSA can be very effective.

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Why Are Traditional Plans So Expensive?

  • Overkill: Government mandates inflate costs with coverages many employees don’t need.
  • Inflexibility: One-size-fits-all plans often need to match individual needs better.
  • Administrative Burden: Managing a traditional health plan is time-consuming, especially for small businesses.

Alternatives in Detail

Health Sharing Programs

    • How they work, cost-saving potential, vs. traditional insurance
    • May have waiting periods for pre-existing conditions
    • Often, don’t restrict provider network

Health Reimbursement Arrangements (HRAs)

    • How they work, tax benefits for employer and employee
    • QSEHRAs specifically for small businesses

Direct Primary Care (DPC)

  • Unlimited primary care for a flat fee
  • Often combined with HSA or health sharing plan
  • Emphasizes preventive care, reducing overall costs

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Health Savings Accounts (HSAs)

  • Tax-advantaged savings for medical expenses
  • Must be paired with a high-deductible health plan
  • Employer contributions are tax-deductible

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Additional Considerations

  • The Small Business Health Care Tax Credit May apply to your business
  • Combining Strategies: Example – DPC + HSA + health sharing


Contact an HSA for America Personal Benefits Manager for a free analysis and recommendation tailored to your Missouri business.

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Frequently Asked Questions

About Small Business Health Insurance in Missouri

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Can I Offer Health Insurance and Health sharing at the same time?

Yes, you can offer both options side by side, allowing employees to choose which plan suits their needs best.

Note if too many employees opt out of a group health insurance plan, you could fall below the minimum participation rate required to maintain a group plan. However, you can always use an HRA to reimburse the employees for individual health insurance, which will be close to the same cost. 

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Are there waiting periods for pre-existing conditions with health sharing plans?

Yes, some healthsharing plans may have waiting periods for pre-existing conditions before coverage begins. It’s important to review the plan guidelines or consult with a Personal Benefits Manager for more information on specific plans.

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Can employers contribute to their employees’ HSAs in Missouri?

Yes, employers are allowed to make contributions to their employees’ HSAs, subject to annual limits set by Congress.


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Does offering a Direct Primary Care (DPC) plan alongside other coverage options make sense for small businesses in Missouri?

Combining DPC with low-cost coverage options like health sharing plans can provide comprehensive and cost-effective healthcare solutions for small businesses and their employees.

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Can a business still claim the Small Business Health Care Tax Credit if they don’t owe taxes in Missouri?

Yes, even if a business doesn’t owe taxes in a particular year, the Small Business Health Care Tax Credit can be carried back to offset income tax liability from the previous year or carried forward for up to 20 years.

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What is an HRA (Health Reimbursement Arrangement) and how does it work?

An HRA is an employer-funded account that reimburses employees for qualified medical expenses not covered by their insurance plan. Employers determine what expenses are eligible and contribute funds accordingly.

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Is there any limitation on the size of small businesses eligible for these programs in Missouri?

The Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is only available to employers who have fewer than 50 employees. However, if you have more than 50 employees, or your company grows to have more than 50, there are other types of HRAs available to you.

You will also have an ACA requirement to provide a qualified health insurance plan for your employees, or pay a penalty. If you are on the cusp, or planning to hire your 50th full-time worker or equivalent in the near future, speak with your Personal Benefits Manager, as that could affect your plan design.

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What is the difference between health insurance and healthsharing for small businesses

Health insurance is a traditional coverage plan offered by insurance companies, while healthsharing involves members contributing to a pool of funds to cover each other’s medical expenses.

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    How can Health Savings Accounts HSAs help manage medical costs for employees in Missouri?

    HSAs allow individuals to set aside pre-tax money to save for future medical costs. Both employers and employees can contribute, providing tax advantages and potential savings on healthcare expenses.

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    Can employer contributions towards HSAs be deducted from state income tax in Missouri?

    Yes. Employer contributions towards employee HSAs are fully deductible from state income tax as a compensation expense in Missouri.


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    How do I claim the Small Business Health Care Tax Credit?

    The tax credit can be claimed on the annual income tax return with IRS Form 8941 for for-profit businesses, while tax-exempt small businesses must file a Form 990-T tax return.

    HSA for America does not provide tax advice. Employers should consult their tax advisor for full information on claiming the credit.


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    Are maternity benefits covered by health sharing plans in Missouri?

    Maternity benefits are commonly included in health insurance policies and healthsharing plans in Missouri, covering prenatal care, labor, and postnatal care. However, some health sharing plans may have restrictions on cost-sharing benefits for children conceived outside of marriage.

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    Can HRAs be used alongside other coverage options like health sharing plans or individual health insurance plans?

    Yes, HRAs can be used alongside other coverage options. Some small businesses choose to cancel group health insurance altogether and use HRAs to reimburse employees’ premiums for individual policies. However, HRA money cannot be used to reimburse employees directly for health sharing plan costs.

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    How can I determine which combination of health insurance and cost-sharing options is best for my small business in Missouri?

    Don’t go it alone. Contact a Personal Benefits Manager who can conduct a free analysis and recommendation based on your specific needs, budget, employee census, and any pre-existing conditions that need to be considered. They can help design an optimal plan that maximizes the value for your employees while controlling costs and helping you remain competitive. 


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    Disclaimer: All information on this website is relayed to the best of the Company's ability, but does not guarantee accuracy. Information may be out of date. The content provided on this site is intended for informational purposes only and does not guarantee price or coverage. This site is not intended as, and does not constitute, accounting, legal, tax, and/or other professional advice. Determination of actual price is subject to Carriers.