An Apple a Day . . .

Limited medical-care plans, which cover everyday medical expenses like doctor visits but not catastrophic illness and injuries, are also an option for employers. "This is the fastest-growing segment in the insurance industry today," says Derek Peterman, founder and CEO of Century Healthcare, a limited-benefit insurer. Premiums are low enough that middle-class workers and smaller companies can afford them, he says, and higher-paid workers often supplement them with major medical plans to form a plan similar to conventional insurance.

Professional employer organizations can help many small businesses save double-digit percentages on their health premiums. These entities essentially hire an entrepreneur’s employees, handling payroll processing and other overhead functions, including health benefits, for a monthly fee. PEOs may employ thousands of people, making them eligible for group discounts from insurers.

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Government help may also be available to some companies. Last year, Massachusetts became the first state to require that all citizens have health coverage. As part of the effort, the state persuaded insurers to offer bare-bones plans at low prices. Among the law’s other provisions are fines for businesses that employ more than 11 but don’t offer coverage. And it lets individuals and companies with up to 50 employees pay insurance premiums with pretax dollars. But Jacobson says the Massachusetts plan mostly benefits the uninsured and unemployed and may still be too expensive for all but young, healthy workers. 

Entrepreneurs can expect little immediate help--premiums are expected to rise at about the same rate into the forseeable future. In some cases, the trend may be worsening. For employers relying on HMOs, consulting firm Hewitt Associates says 2008 increases will average 14.1 percent. That’s up from 11.7 percent in 2007.

Crawforth feels he must offer health coverage to compete for workers in Boise’s tight technology labor market. And while his costs haven’t gone up, he’s seeing new insurance options, including a plan offered by the national company that processes his payroll. "It’s becoming easier," he says. "I’m finding there are more avenues to get health insurance."