Small business health insurance in Ohio

How Ohio's market is set up

Ohio uses the federal marketplace at HealthCare.gov, and the Ohio Department of Insurance approved 11 companies to sell on the 2026 exchange; one county has three insurers and every other county has four or more (Ohio DOI, 2026 Federal Exchange Plans; county availability list, August 2025). Premiums follow the federal defaults — a 3:1 age curve and tobacco rating up to 1.5:1 (CMS, State Specific Rating Variations).

Ohio Revised Code §3924.01 defines a small employer as one that employed an average of at least two but no more than 50 eligible employees on business days during the preceding calendar year. CMS divides the state's 88 counties into 17 rating areas.

What an Ohio group plan costs in 2026

Ohio was one of the states with larger proposed small-group increases for 2026, at an average of about 16% against a national median of 11% across 318 small-group insurers (Peterson-KFF Health System Tracker, September 24, 2025). Those are proposed, not final, figures; the Ohio Department of Insurance did not publish an approved statewide average that we could verify, so we do not state one. For the individual market the same caveat applies — the national median proposed increase was 18%, and Ohio's approved figure was not available from an authoritative source.

What a 16% small-group proposal means in practice: a $700-per-employee-per-month group plan becomes $812. A group renewal at that level is the moment most Ohio employers start comparing an allowance they set against a premium they do not.

Your four real options as an Ohio employer

There are four ways to offer health insurance to employees in Ohio, and the state's market rules change how each one performs.

• A small-group plan (2–50 employees) through a carrier or the SHOP route. Predictable coverage, age-rated premiums, annual renewals, participation and contribution minimums.
• A PEO, which pools your staff into its own group plan and bundles payroll and HR for a fee on top of premiums. See our ICHRA vs PEO comparison.
• A taxable stipend. Simple, but it is wages: you owe employer payroll tax on it, the employee owes income tax, and it does not count as an offer of coverage. See our guide to health insurance stipends.
• An ICHRA — a fixed, tax-free monthly allowance employees use to buy their own individual plan on or off HealthCare.gov. No participation minimum, no renewal negotiation, and the allowance is a number you choose.

The Ohio ICHRA tax credit bill: HB 133

HB 133 (136th General Assembly), sponsored by Representative Meredith Craig, would enact ORC §5747.87 to authorize a nonrefundable income tax credit for small employers that cover their employees with an individual coverage health reimbursement arrangement, and would prohibit practices intended to steer individuals away from employer-provided insurance. It was introduced February 24, 2025, reported by House Ways and Means June 3, passed the House June 4, and was referred to Senate Ways and Means on June 11, 2025, where the official record shows no further action (Ohio House and Senate legislation records). The 2025 state budget, HB 96, contains no ICHRA provision (Legislative Service Commission analysis as enacted).

So there is no Ohio ICHRA credit in law today. If HB 133 passes, it is upside; plan the arrangement on its own economics. Our ICHRA state tax credits page tracks it.

The Medicaid trigger and your lowest-paid staff

Ohio adopted Medicaid expansion on January 1, 2014 (KFF). The 2025 budget, HB 96 — signed June 30, 2025 — requires the Department of Medicaid to immediately terminate coverage for the expansion group if the federal government sets the federal match below 90%, with a phased transition redirecting enrollees toward private insurance subsidies or charity care (LSC, HB 96 analysis as enacted). It has not been triggered. For an employer with lower-wage staff, it is worth knowing that the coverage some employees rely on has a statutory off-switch: an ICHRA allowance is a funded path onto an individual plan that does not depend on it.

Setting an ICHRA allowance in Ohio

Ohio rates individual premiums on the federal 3:1 age curve, so a 64-year-old's premium can be up to three times a 21-year-old's for the same plan. Federal ICHRA rules let you vary the allowance by age up to that same 3:1 ratio, and in an age-rated state that is usually the fair design: a flat allowance treats a 25-year-old and a 60-year-old very differently in real purchasing power.

Location matters too. Ohio's 17 rating areas mean a Columbus premium and an Appalachian-county premium differ. In our 2026 calculator dataset (the figures shown on our ICHRA in Ohio page), the lowest-cost Silver plan for a 40-year-old in Ohio averages about $524/month, ranging from $409 to $665 across the state's 88 counties. That spread is why an allowance set from a statewide average fails the ACA affordability test in some counties and over-funds others.

Our ICHRA calculator uses those county-level 2026 lowest-cost Silver premiums by ZIP code, so you can see the affordability line for each employee before you set a number. For 2026, an offer is affordable when the employee's cost for the lowest-cost Silver plan, minus your allowance, is no more than 9.96% of the applicable income measure (IRS).

Group plan vs. ICHRA for an Ohio employer

Ohio's individual market is unusually deep for an ICHRA — 11 carriers, four or more in nearly every county — while its small-group market proposed one of the larger 2026 increases. The table puts the two side by side.

How to set up an ICHRA in Ohio

The setup is the same federal process as anywhere: adopt a written plan document, define employee classes, set the allowance (by age band and rating area if you choose), deliver the required employee notice at least 90 days before the plan year begins, and reimburse against proof of individual coverage. Give employees a clear enrollment path — HealthCare.gov or an off-exchange carrier — and time the launch to a window when they can actually enroll: the annual open enrollment, or the special enrollment period that a new ICHRA offer triggers.

Who we are

The ICHRA Broker is licensed in New York and works with employers nationwide, including Ohio. We design, set up, and support ICHRAs for small and mid-sized employers — the county-by-county allowance work, the affordability testing, and the enrollment support employees need. Free quote, no obligation. This page is education, not tax, legal, or insurance advice.

Sources

• Ohio Department of Insurance, 2026 Federal Exchange Plans (11 companies) and PY2026 on-exchange QHP availability by county (August 7, 2025).
• Ohio Revised Code §3924.01 (small employer: 2–50), codes.ohio.gov.
• Peterson-KFF Health System Tracker, small-group premiums 2026 (Ohio ≈16% proposed; national median 11%) and individual-market premiums 2026 (national median 18%).
• Ohio House and Ohio Senate legislation records, HB 133 (136th GA); LSC bill analysis of HB 96 as enacted (Medicaid provisions).
• KFF, State Activity Around Expanding Medicaid (Ohio: adopted 1/1/2014; trigger law).
• CMS, Ohio Geographic Rating Areas (17); Market Rating Reforms — State Specific Rating Variations.
• The ICHRA Broker calculator dataset: 2026 lowest-cost Silver premiums by ZIP.