Compare the ways small and mid-sized businesses actually buy health coverage — including if you are not required to offer a plan
Shops under 50 full-time employees do not have to offer health insurance. The usual menu is: offer nothing, stand up a small-group plan, give a defined-contribution HRA, pay a taxable stipend — or start with Direct Primary Care.
How do you cover people today?
About 8 employee-only and 4 family enrollments
At 12 employees you are not required to offer health insurance. A group plan is optional. Many Columbus-area shops offer nothing; Cove DPC is a way to put a real benefit in place without a carrier contract.
Annual employer cost for 12 employees. Bars are scaled to the highest option. PEPM is the employer cost per employee per month.
Adding Cove DPC at 100% would cost about $10,800/year — $75 per employee per month. A typical small-group plan for this team is about $96,667/year.
$0/year · $0 PEPM
Legal if you have fewer than 50 full-time employees. Many small shops do this today — employees use the marketplace, Medicaid, a spouse’s plan, or go uninsured.
Employees get: No employer-paid medical benefit.
Harder to recruit. Employees still need a plan for hospital and specialist care.
Recommended for your situation
$10,800/year · $75 PEPM
A flat monthly membership for unlimited primary care — visits, texts, and chronic-care management — with no copays and no insurance billing.
Employees get: Same-day or next-day primary care and 24/7 access. Not hospital or specialist coverage.
Employees still need a way to cover hospital and specialist bills — a marketplace HDHP, a spouse’s plan, or a health-sharing ministry. Cove does not sell those.
$55,728/year · $387 PEPM
Cove handles everyday doctor visits. A smaller defined-contribution HRA (modeled at 60% of a full medical allowance) helps employees buy high-deductible major medical.
Employees get: Unlimited primary care at Cove, plus an allowance toward major-medical coverage.
Often the closest substitute for a group PPO at a fraction of the premium, without standing up a carrier plan.
$62,006/year · $431 PEPM
Extra taxable wages earmarked as a “health stipend.” Simple payroll, but it is not a health plan.
Employees get: Cash. They may or may not spend it on coverage.
Employer FICA of 7.65% is included. Employees typically lose ~30% to income tax and FICA, so a $400 stipend is worth much less in their pocket than the same dollars in an HRA.
$74,880/year · $520 PEPM
A tax-free allowance toward individual coverage. QSEHRA is only for shops under 50 that do not also offer a group plan; ICHRA works at any size.
Employees get: A tax-free allowance to buy an individual ACA plan of their choice.
2026 QSEHRA caps are $538/mo self-only and $1092/mo family. Amounts above that require an ICHRA.
$96,667/year · $671 PEPM
A traditional fully insured (or level-funded) group policy. One or two plan options, carrier network, deductibles, and annual renewals.
Employees get: Employer-sponsored medical plan. Primary care is billed through insurance.
Carriers often require ~50% employer contribution and 60–70% participation. Renewals of 8–15% are common. Level-funded plans can cost less for a healthy group but shift claims risk back to you.
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Educational estimate, not a quote, tax opinion, or ERISA advice. Direct Primary Care is not insurance and is not minimum essential coverage. Health-sharing ministries are not insurance and are generally not an employer-sponsored group plan. QSEHRA cannot be offered alongside a group health plan. ICHRA affordability and the employer mandate depend on your design and payroll. Confirm premiums, participation rules, and contribution limits with your broker, CPA, or benefits counsel. HSA funds can be used for DPC membership fees under the One Big Beautiful Bill Act.
Bring a headcount and any current premiums — we’ll walk through DPC as a standalone benefit or paired with an HRA or HDHP.
