With fewer than 50 employees you can purchase small-group market coverage either directly from an insurance company or with the help of an agent or broker. If you choose to purchase small-group coverage, you will be able to continue with your plan even if you go over 50 employees, so long as you meet all other eligibility rules (for example, you must offer coverage to all full-time employees).
The Affordable Care Act also applies “shared responsibility” requirements to employers with more than 50 full-time or full-time equivalent employees. While it does not directly require such employers to offer health insurance, it imposes financial penalties if their employees qualify for premium tax credits for individual coverage, either because the employer did not offer coverage or offered coverage that was deemed unaffordable or to not provide minimum value.
Currently, groups with more than 50 employees are subject to different rules than groups with 50 or fewer employees. For example, insurers offering coverage to large groups do not need to provide the essential health benefits package, while they are required to offer such coverage to small groups. (45 C.F.R. 147.106; 78 Fed. Reg. 65046, Oct. 30, 2013). They also cannot charge a small employer higher premiums based on employees’ health status, while they can do so for groups with more than 50 employees.