# Is Gusto health insurance good quality?

Source: https://www.getprescience.com/guides/is-gusto-health-insurance-good
Author: Aditya Jain, MD, Cofounder and COO, Prescience
Published: 2026-10-07
Updated: 2026-10-13
Cite as: Aditya Jain, MD. "Is Gusto health insurance good quality?." Prescience, October 13, 2026. https://www.getprescience.com/guides/is-gusto-health-insurance-good

Gusto doesn't make health insurance. It's a licensed broker that sells standard small group plans from carriers like Blue Shield, Aetna, Kaiser and United inside its payroll dashboard. So the quality of "Gusto health insurance" is the quality of whichever carrier plan you pick, at the carrier's price. Gusto makes buying easy; it doesn't make the plan cheaper or better.

- **What Gusto is:** Payroll company and licensed broker
- **Who insures you:** The carrier you choose
- **Extra fee when Gusto is broker:** None; paid via carrier commission
- **Fee with an outside broker:** $6 per eligible employee/month

## How Gusto health insurance works

Gusto acts as the insurance broker for coverage it sells and provides enrollment and payroll administration. It says Gusto-brokered health insurance administration has no additional fee beyond premiums. For an outside broker, its Help Center lists $6 per eligible employee per month on Simple and Plus. Premium customers already on that tier as of October 1, 2026 are described as grandfathered into free integration; customers joining on or after that date are charged $6. The wording overlaps on October 1 itself, so confirm that boundary in writing.

Gusto says it supports health benefits in all 50 states and Washington, D.C., with 30+ carriers, though the carriers and plans you can pick vary by state. Plans are issued by those carriers; Gusto doesn't underwrite or guarantee coverage.

Ask Gusto to disclose the compensation and services attached to your proposal. A broker can help compare plans, but the carrier’s coverage documents govern benefits and claims. Do not infer that a separate intermediary participates in your policy without seeing the relevant disclosures.

**What Gusto charges around health insurance (October 2026, from Gusto's pages)**

| Item | Simple | Plus | Premium |
| --- | --- | --- | --- |
| Payroll base price | $49/month | $80/month | $180/month |
| Per person | $6/month | $12/month | $22/month |
| Health plan bought with Gusto as broker | Premium only | Premium only | Premium only |
| Connect a plan from your own broker | $6 per eligible employee/month | $6 per eligible employee/month | $6 unless grandfathered; confirm October 1, 2026 boundary |

HSA and FSA administration, ACA reporting for larger employers and COBRA administration are separate add-ons with their own fees. Check the current list on Gusto's pricing page before you budget.

## So is the insurance good?

For the same ACA-compliant small-group product, census and effective date, carrier rating rules apply regardless of the broker. Another broker may offer different products or services. Match the exact plan identifier before calling two quotes equivalent.

- **Network:** check the actual provider directory. PPOs usually allow out-of-network benefits, while HMOs and EPOs generally restrict routine care to their networks. A network label does not establish its size or price.
- **Deductible and out-of-pocket maximum:** what your team actually pays when they get care.
- **Metal level:** bronze, silver, gold and platinum change premiums and cost-sharing.
- **Prescription tiers:** a plan can look rich on paper and still put common drugs behind a deductible.
- **HSA eligibility:** high-deductible plans let employees save tax-free, but they pay full price for most care until the deductible is met.

What Gusto can't do is change the economics. You're still buying a fully insured small group plan, so you pay the carrier's rates, and the carrier keeps whatever it doesn't spend on claims. Under the ACA, small group prices can vary only by age, tobacco use, location and family size. Your team's health doesn't move the price, and a healthy team doesn't get a discount for low claims. Carriers must spend at least 80% of small group premiums on care and quality improvement; the rest covers administration, commissions and profit.

## What a 12-person team pays through Gusto

Founders sometimes compare Gusto's software fee with a PEO's fee and conclude Gusto health insurance is cheap. The software fee is small. The premium is the cost.

**12 employees on Gusto Plus, 10 enrolled in single coverage (illustrative)**

Assumes the KFF 2025 average single premium at firms with 10–199 workers ($9,211 a year, about $768 a month), the employer paying 80% of it, and Gusto acting as broker. Real premiums depend on your state, ages and plan.

- Gusto Plus payroll: $80 + 12 × $12: $224/month
- Health admin fee with Gusto as broker: $0
- Premiums: 10 enrolled × $768: $7,680/month
- Employer share (80%): $6,144/month
- Employee share (20%): $154/month each
- Same plan via an outside broker, connected to Gusto: +$72/month (12 × $6)

About $73,700 a year in employer premiums against about $2,700 a year in payroll software. Whatever you decide about Gusto, the plan's price and design drive almost all of the cost, and that price is the carrier's, not Gusto's.

## Where Gusto is strong, and where it isn't

**Gusto health insurance, fairly**

| Strengths | Limits |
| --- | --- |
| Benefits, payroll deductions and new-hire enrollment live in one place | Prices are the carriers' filed small group rates; Gusto can't negotiate them |
| No extra admin fee when Gusto is your broker | Commission is built into the premium either way |
| Licensed benefits advisors and a broad carrier list in most states | Carrier and plan choice varies by state, and some local plans may not be offered |
| Works for very small teams if carriers' participation rules are met | Renewals follow the carrier's annual rate changes; Gusto can only re-shop |
| ICHRA through partners such as Thatch | Confirm the current partner, fee and administration scope if you want an ICHRA or QSEHRA. |

Ask which claim and billing questions Gusto’s advisors will help escalate and which must go directly to the insurer. The carrier decides coverage and prior authorization under the policy. Obtain the service scope and response channels before buying rather than assuming brokerage assistance stops at enrollment.

## What happens at renewal

Small group plans renew once a year. The carrier sets the new rates from its filed rate changes and your team's new ages, and Gusto passes them on with a renewal notice. KFF's 2025 survey found average employer premiums rose about 5% for single coverage and 6% for family coverage in one year, and family premiums rose 26% over five years. A cheap first year doesn't protect you from that.

- **Guaranteed issue and renewal.** A small group carrier can't refuse your group or drop it because someone got sick.
- **Age steps.** Age can affect premiums where state law permits it, but not every birthday changes the factor. New York and Vermont prohibit age rating in these markets. Renewal comparisons must separate rate changes from census and enrollment changes.
- **Re-shopping.** Request other available carrier plans at renewal. Review cancellation, participation and enrollment terms before switching; do not assume every contract can end without a charge.
- **Mid-year changes.** Changing carriers mid-year is possible, but deductibles usually restart on the new plan unless the new carrier gives credit. Read [switching health insurance mid-year](https://www.getprescience.com/guides/switch-health-insurance-mid-year).

## Questions to ask before you buy through Gusto

1. Which carriers and plans are available in our state and county, and which are missing compared with an independent broker?
2. What are the carrier's participation and employer contribution minimums for a group our size?
3. Are our main hospitals and our employees' doctors in network? Check each plan's provider directory yourself.
4. What is the out-of-pocket maximum, not just the deductible, for single and family coverage?
5. How are specialty drugs and common prescriptions covered before the deductible?
6. Who handles COBRA or state continuation for people who leave, and what does it cost?
7. What did this carrier's renewals look like for similar groups last year?

## Your options if you're on Gusto payroll

**Ways to offer health insurance while running payroll on Gusto**

| Option | What you get | Good fit when |
| --- | --- | --- |
| Gusto as broker | Carrier small group plan, enrollment in Gusto, no admin fee | You want a standard plan quickly and price isn't the main issue |
| Outside broker, connected to Gusto | Same carrier plans, a broker who can shop more widely, $6 per eligible employee on Plus | You want a local broker's advice or a carrier Gusto doesn't offer in your state |
| ICHRA through a Gusto partner | A monthly allowance employees spend on individual plans | Your team is young, single and spread across states. Read [Is ICHRA a scam?](https://www.getprescience.com/guides/is-ichra-a-scam) first |
| A PEO | The PEO's large group plan, but you move payroll to the PEO too | You want HR outsourced as well as benefits |
| Prescience | A company health plan while keeping your current payroll provider | You want a richer plan at a lower fixed cost and to keep Gusto payroll |

> **Prescience Choice: ICHRA for $20 per enrolled employee per month.** Looking at the ICHRA row? Choice is $20 per enrolled employee per month, and it works alongside Gusto payroll.
> - **You set a monthly allowance;** each employee picks and owns an individual plan
> - **$20 per enrolled employee per month,** with no setup or platform fee
> - **Works in all 50 states and DC,** so remote and multi-state teams fit
> - **Plan comparison, enrollment help and Crystal,** our assistant for benefits questions
> Best for small teams, teams in several states, and anyone pricing ICHRA. [Get a Choice quote](https://www.getprescience.com/employer/choice)

## My take

**When Gusto health insurance makes sense**

| Your situation | My take |
| --- | --- |
| Already on Gusto payroll, want a standard plan fast | Gusto is a convenient way to buy it |
| Want lower cost than carrier rates | Gusto can't help; the price is the carrier's |
| Want a richer plan for recruiting | Look at a Prescience plan |
| Want to keep Gusto payroll but change insurance | Compare a new health plan while keeping your payroll provider |

Gusto is good at what it is: a payroll company that makes buying a standard plan painless. If a standard carrier plan at the carrier's price is what you want, buying it through Gusto is reasonable. If you want something better than a standard plan, the answer won't come from the payroll dashboard.

## How to change insurance and keep Gusto payroll

1. **Pull your current plan details** From Gusto, download plan summaries, the employee census and your renewal date. Note any carrier notice requirement for cancelling.
2. **Get quotes 60–90 days before your target start** Send the census to the new provider. Ask for the total monthly cost, the employee contribution by tier and the network.
3. **Pick a start date on the 1st of a month** Set the new plan to start the day after the old one ends so nobody has a gap.
4. **Enroll employees and set deductions** Run enrollment, then add the new plan's deductions in Gusto (or let the new provider's integration do it) before the first payroll on the new plan.
5. **Cancel the old plan in writing** Cancel through Gusto or the carrier with the exact end date, and confirm the final premium bill.

## Keep Gusto payroll, upgrade the plan

At Prescience, we design and run your company's health plan, from setup and enrollment to claims, compliance and COBRA. What your team gets:

- **An effective $0 deductible,** so the plan helps from the first visit.
- **Simple copays** shown before a visit, capped by a low out-of-pocket maximum.
- **A broad national PPO network,** plus providers we contract with directly.
- **24/7 physician-led care navigation:** a care team that finds the right provider, books appointments and explains costs up front.

What your company gets: one monthly cost set in your quote, usually 10–20% below comparable fully insured coverage and fixed before the plan starts, with no admin fees. You keep your payroll provider, and the plan can start mid-year.

> **Prescience Diamond: A company health plan with an effective $0 deductible.** Keep running payroll on Gusto and swap the carrier plan for Diamond: deductions keep flowing through the same dashboard.
> - **An effective $0 deductible** and simple copays shown before a visit
> - **A broad national PPO network,** plus providers we contract with directly
> - **24/7 physician-led care navigation** that books visits and explains costs
> - **Usually 10–20% below comparable fully insured coverage,** fixed in your quote, with no admin fees
> Best for teams of about 15 or more that want one great group plan. [Get a Diamond quote](https://www.getprescience.com/get-started?p=Employer&product=diamond)

## Make the brokerage decision at renewal

I would keep Gusto as broker when its available plans meet the team’s needs and its support is worth keeping. I would consider an outside broker if the missing carrier, specialized advice or continuity service justifies the integration charge. Ask both to price the same effective date and enrollment tiers. A lower software fee is not evidence that one health plan covers more care.

Before changing the broker of record, confirm whether the insurer, network and plan remain the same. A broker change and a coverage change are different transactions. If only the broker changes, ask about commission timing, service responsibility and system access. If the policy changes, also verify enrollment, prior authorizations, deductible credits and termination dates. Keep a written record of who will answer employee questions during the handoff.

## Frequently asked questions

**Does Gusto provide its own health insurance?**

No. Gusto is a licensed broker that sells small group plans from carriers such as Blue Shield, Aetna, Kaiser and United. The carrier insures your team.

**Does Gusto charge for health insurance?**

Gusto-brokered administration has no separate health administration fee beyond premiums. External broker integration is $6 per eligible employee per month on Simple and Plus and for new Premium customers from October 2026, subject to the Help Center’s grandfathering exception. Confirm your contract, especially if you joined Premium on October 1.

**Is Gusto health insurance cheaper?**

Not usually. Small group plans are sold at the carrier's filed rates whichever broker you use. Gusto makes buying easier, not cheaper.

**Which states does Gusto offer health insurance in?**

Gusto says it supports health benefits in all 50 states and Washington, D.C. The carriers and plans available differ by state.

**Does Gusto offer ICHRA or QSEHRA?**

Gusto lists health reimbursement options through partners. Confirm the current ICHRA or QSEHRA administrator, eligibility rules and separate fees before enrollment.

**Is Gusto's health insurance good for a two-person company?**

It can be, if carriers in your state accept groups that small and you meet their participation and contribution rules. The plan quality is the carrier's either way.

**Can I keep Gusto payroll and use Prescience for health insurance?**

Yes. Prescience lets you keep your current payroll provider. Confirm the deduction setup before enrollment.

**Who do employees call with claims questions on a Gusto plan?**

The carrier makes claims and authorization decisions. Ask Gusto what help its advisors provide with escalation, enrollment errors and billing, and keep both support contacts available.

## Sources

- [Gusto, health benefits](https://gusto.com/product/benefits/health)
- [Gusto, published pricing](https://gusto.com/product/pricing)
- [Gusto Help Center, broker integration and October 2026 pricing exception](https://support.gusto.com/article/220623140746493/broker-integration-connect-existing-insurance-plans-to-gusto)
- [CMS, market rating reforms and state variations](https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/state-rating)
- [CMS, medical loss ratio rules](https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio)
- [KFF, 2025 Employer Health Benefits Survey (original survey and methodology)](https://www.kff.org/health-costs/2025-employer-health-benefits-survey/)
- [DOL, plan information and disclosure](https://www.dol.gov/general/topic/health-plans/planinformation)