A plain-English guide for small business owners
Every realistic way a small Montana employer can offer healthcare, what each one costs, who it fits, and what to watch out for. No single right answer, and no pitch.
Start here
Most owners start by asking "what does a plan cost?" and get quoted a monthly figure that answers half the question. What your team actually pays, whether they can get in to see a doctor, and what happens if someone lands in the hospital are separate decisions hiding inside that one number.
This guide lays out every realistic path for a small Montana employer in the same format, so you can compare them honestly. Some cost less. Some cover more. None do both. Knowing which trade-off you're making is the whole job.
Can you budget the number a year out, or does it move at renewal?
Will people actually go to the doctor, or wait until it's expensive?
What happens if someone has a surgery, a cancer, a bad accident?
How many hours a month does it take from you or your office manager?
The rules
The threshold that matters
50 FTEs
Under 50 full-time-equivalent employees, federal law does not require you to offer healthcare. Almost every Montana small business is here, which means your choice is genuinely a choice.
Carriers usually require a minimum share of employees to enrol and a minimum employer contribution. Ask for both numbers before you fall in love with a quote.
In the ACA small-group market, rates are set by age, family size, geography and tobacco use, not by how healthy your crew is. A young team doesn't automatically get a bargain.
Handing employees cash for healthcare can create tax problems. The compliant versions are formal arrangements, ICHRA and QSEHRA, covered below.
Group arrangements can start most months, but individual plans are tied to open enrolment and qualifying life events. Start comparing 60 to 90 days before renewal.
Your options
Most businesses land on one of these, or a combination of two. Read them as building blocks, not a ranking.
You buy a plan from a carrier for the whole team and split the cost. The familiar path, usually arranged through a broker.
Fits: teams that want one recognisable plan and broad network access.
Watch: renewal increases, participation minimums, and high deductibles that keep people from using it.
You set a monthly allowance; employees buy their own individual plan and get reimbursed tax-free. No IRS cap on what you contribute.
Fits: owners who want a fixed, budgetable number and employees who want to keep their own doctor.
Watch: employees must shop for a plan, and accepting the allowance can affect their marketplace tax credit.
The simpler reimbursement arrangement for employers under 50 FTEs with no group plan. For 2026 the IRS caps it at $6,450 per year for self-only and $13,100 for family.
Fits: very small teams wanting a clean, uniform benefit with little administration.
Watch: the cap may not go far; it can't be offered alongside a group plan; W-2 employees only.
You pay a fixed monthly amount that funds your own claims plus stop-loss insurance, and may get money back in a good year.
Fits: healthier groups of roughly 10+ employees willing to take on some risk for upside.
Watch: underwriting, claims volatility, and a renewal that can move hard after a bad year.
A monthly membership covers everyday care directly with local providers, primary care, labs, imaging, therapy, often paired with a cost-sharing community for large bills. This is where CoreMed sits.
Fits: teams who use everyday care and want a predictable number; often 40 to 60% less than group rates.
Watch: it is not insurance; cost sharing is not guaranteed payment; check what's excluded before you switch.
Employees buy marketplace coverage, often with tax credits based on household income, and you pay wages instead of premiums.
Fits: very small or seasonal teams where tax credits beat anything you could buy for them.
Watch: recruiting and retention, and the fact that a raise is taxed while a benefit generally isn't.
Combinations are common and often the best answer: a high-deductible group plan paired with a membership for everyday care, or an ICHRA alongside a direct primary care membership. Ask each provider what they pair well with.
Comparing them
The monthly figure is one of four numbers. Add all four for each option before you compare anything.
Number 1
Premium or allowance, per employee, per month.
Number 2
Their share, plus the deductible and copays before anything kicks in.
Number 3
Maximum out-of-pocket, or the exposure if a large bill isn't shared.
Number 4
Deferred care, sick days, turnover. Real money, rarely on the quote.
| Option | Cost predictability | Everyday care | Big bills | Tax-advantaged | Admin load |
|---|---|---|---|---|---|
| Small-group insurance | Low, moves at renewal | Behind the deductible | Strong, contractual | Yes | Moderate |
| ICHRA | High, you set the allowance | Depends on the plan chosen | Strong, contractual | Yes | Low with an administrator |
| QSEHRA | High, capped by the IRS | Depends on the plan chosen | Strong, contractual | Yes | Low |
| Level-funded | Medium, fixed year, volatile renewal | Behind the deductible | Strong, with stop-loss | Yes | Higher |
| Membership + sharing | High, flat monthly amount | Included, no deductible first | Shared, not guaranteed | Ask your CPA | Low |
| No employer plan | Highest, you pay nothing | On the employee | On the employee | N/A | None |
2 to 9 employees
Compare a QSEHRA or ICHRA against a membership model. A full group plan is often more cost and administration than it's worth at this size.
10 to 25 employees
Get a group quote and a level-funded quote, then price a membership model against both. This is where the real comparison lives.
Seasonal or high-turnover
Look hard at ICHRA and at benefits that start on day one without a waiting period, so people are covered while they're on your crew.
Do this next
01
Ages, ZIPs, who has family coverage. Every quote needs it.
02
Decide the per-employee, per-month spend you can sustain for two years.
03
From different models, not three versions of the same one.
04
Doctor access, prescriptions, dependants. Cheap benefits nobody wants are wasted.
05
Give yourself 60 to 90 days before renewal, and run the CPA check.
Ask every broker, carrier or provider
Terms worth knowing
State insurance help line for consumers and employers · csimt.gov
Small-group plans and the small business tax credit · healthcare.gov/small-businesses
Ask them to quote more than one model, and how they're paid
Who published this guide
We're a Montana-based membership healthcare company. We wrote this because owners kept asking us to explain the whole landscape, not just our corner of it. If a broker or an ICHRA fits your team better, that's a good outcome.
