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I am about to join a new US company and will be the only employee for a while. I am not a shareholder or anything similar. The employer cannot offer a group health plan as they normally require at least two employees (at least in Pennsylvania).

Is there any way the employer or myself can pay for an individual health plan with pre-tax money?

I know there are similar questions on this website, but perhaps my case is different because the employer cannot offer a group plan.

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The answer likely depends a bit on which state you are in, but this should be true for most states. I don't know anything about Pennsylvania specifically unfortunately.

The Affordable Care Act created the SHOP marketplace, which allows small businesses to effectively form larger groups for group coverage purposes. SHOP stands for Small Business Health Options Program, and requires only one common-law employee on payroll.

This would effectively allow you to offer group coverage without having a group. Talk to your tax accountant for more details, as this is still very new and not necessarily well understood.

There are some other options, all of which I would highly suggest talking to a tax accountant about as well. HRAs (health reimbursement accounts) allow the employer to set aside pre-tax funds for the employee to use for approved medical expenses; they're often managed by a benefits company (say, Wageworks, Conexis, etc.). That would allow your employee to potentially pick a higher deductible health plan which offers poorer coverage on the individual marketplace (with after-tax dollars) and then supplement with your HRA.

There are also the concept of Employer Payment Plans, where the employer reimburses the employee for their insurance premiums, but those are not compatible with the ACA for the most part - although there seems to be a lot of disagreement as to whether it's possible to have something effectively the same work, see for example this page versus this for example.

  • Thanks for the detailed answer! If the employer offers a SHOP plan, can I pay for 100% of the premiums with pre-tax money (a part of my salary)? – dashme Sep 24 '15 at 8:56
  • I'm not an expert, but that's my understanding. – Joe Sep 24 '15 at 15:08
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Pre tax insurance is not possible unless the emplyer provides hsa and do a payroll deduction. Obamacare is all post tax and you can do deduction if your expenses exceeds 10%of your income

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