If you run a small business in Buffalo, you have three real options for health insurance: a traditional small-group plan, a self-funded or level-funded (ERISA) plan, or sending your team to the individual market with a reimbursement setup. Which one saves you money depends on your group's size, health, and budget — and here in New York, our community-rated rules change the math in ways most people don't realize. My job is simple: I educate, you decide.
I'm Dick Tracy, an independent health insurance broker right here in Western New York. I'm not tied to one carrier, so I'm not here to sell you the one plan I happen to carry — I'm here to show you all of them, side by side, and let you pick. I left the healthcare side of this business so there's no gag clause on me. I'll tell you the tips, the tricks, and the traps. So let's walk through it.
This is the one most people picture — a plan you offer through a New York carrier. Here's the part that matters: New York is a community-rated state. That means your small-group premium is not based on how healthy or sick anyone is. In a lot of states, a healthy team can get cheaper rates — the redder the state, the better we usually make out. Here in New York, we get shafted a little on that, but community rating also protects folks with some health issues. It's a tradeoff, and it changes which strategy actually wins.
This is the one nobody explains to you, and it's kind of a cheat code for the right group. Instead of handing a fixed premium to a carrier every month, the business pays its employees' claims out of its own pooled fund — with stop-loss insurance sitting on top to cap your risk so one bad year can't sink you. If your team is healthier than average, you keep what you don't spend on claims. That can cost noticeably less than a traditional plan. It's not for everybody — but for a healthy group that wants more control and to actually see where the money goes, it's worth a real look.
You can also skip a group plan and help your employees get individual coverage, sometimes with a reimbursement arrangement so you still contribute tax-efficiently. The New York marketplace works fine for some folks. But heads up — I call it the Unaffordable Care Act for a reason. Marketplace subsidies can get clawed back at tax time if your income comes in higher than you estimated. Uncle Sam always comes back to collect. So before you assume the marketplace is cheapest, it's worth comparing against the other two.
No, and this is the myth I bust most often. Being self-employed, solo, or 1099 does not mean the individual marketplace is your only option. There are real plans built for owners without a payroll of employees. If someone told you otherwise, get a second opinion before you settle.
No. The marketplace isn't your only option, and it's often not the cheapest once you compare. A broker can access private, off-marketplace plans and group options the marketplace never shows you.
It depends on the plan type, how much of the premium you cover as the employer, and the coverage you build. The bigger lever is usually plan design — how we package the everyday stuff and the catastrophic stuff. That's the part I love getting into the weeds on, because that's where the real money is.