Using Gusto for Payroll and Health Insurance? One Option They Don't Show You
If you run payroll on Gusto, its health-insurance tab is Gusto's own in-house brokerage showing a limited menu of carriers — and it won't surface options outside that menu. This guide covers the one that often saves a healthy small team the most (an individually medically underwritten nationwide PPO, where each employee is underwritten into a broader, healthier pool), why standard small-group overprices a healthy team, how to keep Gusto for payroll while bringing your own broker, and when Gusto's built-in options still make sense.
Using Gusto for Payroll and Health Insurance? One Option They Don't Show You
What Gusto's benefits tab actually is
If you're weighing Gusto health insurance alternatives, start with what that benefits tab actually is. Gusto is excellent payroll software. The health-insurance section, though, is a brokerage — Gusto acts as your broker of record through its own licensed team and earns a commission when you buy through it. That's not a criticism; it's just important to understand what you're looking at. Like any single brokerage working off a software menu, it shows a limited set of carriers and plan types, and it generally won't dig into the underwriting factors driving your premium or surface structures outside its lineup. What you see in that tab is a slice of the market, not the whole market.
Why a healthy small team overpays on standard small-group
Traditional small-group coverage prices your business as its own small risk pool. A small pool can't absorb a single large claim — a heart attack, a cancer diagnosis, a serious injury — so carriers price for that risk, and rates climb to anticipate it. If your team is young and healthy, you're effectively subsidizing risk you don't carry.
The fix most software funnels won't show you: individually underwrite each employee and place them into a broader pooled program of other small employers. A larger, healthier pool can substantially reduce rates while keeping strong benefits — but it only happens if a broker actually structures it that way.
What a software benefits funnel shows
- A limited menu of carriers and standard plans
- Your small group priced as its own risk pool
- Little visibility into what's driving the premium
- Structures outside the lineup rarely appear
- Convenient, but a slice of the market
What an independent broker can show
- Options across the wider market, on and off the menu
- Individually-underwritten, broader-pool structures
- The trade-offs behind the price, in plain English
- A nationwide PPO built around how your team lives
- A person who handles claims and renewals with you
The option they don't show: an individually-underwritten nationwide PPO
For a healthy small business, the plan that often wins isn't on the standard menu: an individually medically underwritten nationwide PPO, priced per employee — so a healthier team is rated on its own merits, not lumped into a pool priced for worst-case claims. Dental and vision are included by default.
How it's structured
- Nationwide PPO network — in and out of network
- Each employee underwritten, placed into a broader healthy pool
- Priced per individual (age, ZIP, gender — income isn't a factor)
- Dental & vision included by default
- Enroll any month — not just at renewal
Who it fits — and who it doesn't
- Best for healthy teams that can clear underwriting
- Medically underwritten — not everyone qualifies
- Not designed for significant pre-existing conditions
- Pairs cleanly with Gusto payroll (see below)
Can You Keep Your Own Broker with Gusto?
This is the part owners miss: choosing your own broker doesn't mean giving up the payroll platform your team already uses. Gusto's broker integration lets you keep Gusto for payroll and name RKA as your broker of record. Enrollments and payroll deductions still sync automatically, new-hire onboarding still runs in Gusto, and you get an independent advisor who shops the wider market and handles claims and renewals with you. Gusto's own materials put broker integration at no extra cost on the Premium plan, or a small per-employee fee on lower tiers. Best of both: the software you like, the market access you didn't have.
See what the funnel didn't show your team
Send us your team's ages and a little detail, and we'll compare an individually-underwritten nationwide PPO against what you're seeing in Gusto — side by side, in plain numbers. Keep Gusto for payroll. No cost, no pressure.
When Gusto's built-in options still make sense
Being straight about this matters. An individually-underwritten PPO isn't right for every team. If you have employees with significant pre-existing conditions, a guaranteed-issue plan — which is what Gusto's funnel and the ACA market offer — is generally the better route, because underwritten coverage isn't guaranteed to everyone. If your team's incomes are modest, some employees may do better with a subsidized individual marketplace plan (an approach a QSEHRA or ICHRA can support). If you also cover family or are self-employed yourself, our family coverage guide goes deeper. The point isn't that the menu is bad — it's that it's incomplete. The right move is to compare the underwritten option against the guaranteed-issue one and choose with the full picture.
How to compare, in four steps
1. Know what your Gusto tab is quoting
Note the carriers, plan types, and total cost it's showing. That's your benchmark — a slice of the market, not all of it.
2. Get the underwritten option priced
Have a broker run an individually-underwritten nationwide PPO for your team so you can see per-employee pricing against the group quote.
3. Compare total cost and network
Look past premium to deductibles, out-of-pocket maximums, and whether the plan works nationwide, in and out of network.
4. Keep Gusto, add your broker
Whichever wins, use Gusto's broker integration so payroll deductions and onboarding stay automated — no platform switch.
Common questions from Gusto users
Does Gusto sell the insurance itself?
No — Gusto is payroll software, and its benefits section acts as a brokerage through its own licensed team. When you buy health insurance in Gusto, Gusto is your broker of record and earns a commission. It's a convenient path, but it shows a limited menu, not the whole market.
Can I keep Gusto for payroll but use my own broker?
Yes. Gusto's broker integration lets you name an independent broker of record while keeping payroll in Gusto. Enrollments and payroll deductions still sync, onboarding still runs in Gusto, and you get an advisor who shops the wider market. Gusto lists this at no extra cost on its Premium plan, or a small per-employee fee on lower tiers.
Why would an independent broker beat what I see in Gusto?
Because a broker isn't limited to one software menu. For a healthy small team, an individually-underwritten nationwide PPO — where each employee is underwritten into a broader, healthier pool — can price better than a standard small-group plan rated on your group alone. That structure usually doesn't appear in a software funnel.
Is the underwritten option right for everyone?
No. It's medically underwritten, so it's best for healthy teams and not designed for significant pre-existing conditions. If someone on your team has major health needs, a guaranteed-issue plan is generally the better route. That's exactly why comparing both matters.
What's the underwritten option you keep mentioning?
It's an individually medically underwritten nationwide PPO, priced per employee, with dental and vision typically included. Because it's underwritten and pooled more broadly, a healthy team is often rated more favorably than under standard small-group pricing. We verify your team's doctors before you commit.
Do I have to switch at my group's renewal?
Not necessarily. Individually-underwritten coverage enrolls year-round, so you're not locked to a renewal window. We'll tell you whether it makes sense to move now or wait, based on your current plan and timing.
Get the full market, not just the menu
One quick conversation and you'll see your team's real options — the underwritten nationwide PPO next to your Gusto quote — with doctors verified. Keep Gusto for payroll. Free, no pressure.
Robert Adams · President & Licensed Agent · NPN 19540130 · Licensed in 30 states. RKA Insurance Advisors is an independent brokerage and is not affiliated with, endorsed by, or sponsored by Gusto; "Gusto" is a trademark of its respective owner, referenced here for comparison and identification only. The private option referenced is an individually medically underwritten nationwide PPO plan. Premium and plan figures depend on age, ZIP, gender, plan design, and underwriting outcome, and pricing is per individual. Private medically underwritten plans are not ACA-compliant and are subject to medical underwriting; not all applicants qualify, and they are not designed for significant pre-existing conditions. Broker-integration availability and fees are set by Gusto and subject to change. This content is for informational purposes only and does not constitute insurance, legal, tax, or financial advice.
