Small firms have strengthened benefits, but lag in dental offerings

Over the past few years, small employers’ main priorities around supporting employee satisfaction have largely remained steady.

However, there’s been significant growth in the number of small businesses that prioritize offering better benefits than their competitors. This is reflected in a greater variety of benefits offered, especially supplemental health benefits like accident and critical illness insurance.

Growth has been slowest in offering dental benefits, meaning more small business workers lack dental insurance compared to workers at larger firms.

Nearly 6 in 10 employees at small businesses don’t have access to dental insurance¹⁵

That has potentially serious implications for their oral health, as individuals who don’t have insurance are less likely to visit the dentist. Nearly 6 in 10 working Americans (58%) with dental insurance visit the dentist the recommended two or more times per year, compared to just a quarter (25%) of those without coverage.¹⁶ Given that oral health can directly impact mental and physical health, this could have poor consequences on small business workers’ overall health and well-being.

Among working Americans who are least likely to go to the dentist at least once per year, 65% work for small businesses¹⁷

One way to make benefits packages more competitive to attract and retain talent is by offering a comprehensive range of benefits, including dental. In particular, plans that include enhancements such as diminishing deductibles and coverage for children, are a good investment of benefits dollars because they’re not only affordable, they reflect what consumers want most in a dental plan. Therefore, they're the types of enhancements that will help make products more accessible and appealing.

Small business workers lack a thorough understanding of their benefits, contributing to low financial confidence

Although small business owners’ commitment to providing competitive benefits is clear, this doesn’t necessarily mean their employees are making the most of their offerings.

33% of small business workers rate their benefits knowledge as low, compared to just 19% of workers at larger organizations

Thirty-five percent also report low confidence in their benefits selections, which is associated with lower well-being. Employers should evaluate their benefits education and communications strategies periodically to ensure they provide sufficient guidance for all employees. More than 1 in 5 (22%) of small business employees say their organization’s current benefits communication are not effective at helping them make the right choices. Fifty-six percent of workers at firms with 50–99 employees wish their employer would provide decision support tools to help them select their benefits.

Benefits technology that aids in decision support should be on employers’ radar as it helps employees make the right selections during open enrollment. Since only about 1 in 5 employees (24%) at businesses with <50 employees report being extremely confident in their benefits choices, using data to improve benefits decision-making is vital to boosting employees’ confidence in their selections and, by extension, their well-being.

The fact that such a significant portion of small business employees’ household income falls below the national median (about $70,000) means they’re more likely to be reliant on the benefits they get through their employer.

Given the numerous challenges they’re facing, it’s unreasonable to expect that small businesses can simply increase their workers’ salaries. But they can ensure they’re offering benefits employees need, and that may involve re-evaluating strategy.

Small businesses are increasingly aware of the need to offer robust mental health benefits

One in five adults experience a mental health issue annually, which has a major impact on the workforce.¹⁸ Among small business employees, that rate is more than one in four (26%). Small employers, much like all employers, are feeling the impact of the nation’s mental health crisis.

Sixty-one percent of small employers agree their organization should do more to improve workers’ mental health, up sixteen percent over 2021. Small employers currently offer a range of benefits and policies that address employee mental health.

More than a quarter of workers at small businesses experienced anxiety, depression, or another mental health issue in the past year

However, the two least-offered benefits, behavioral health programs and employee assistance programs (EAPs), are among the most desired mental health benefits. Forty-four percent of workers at companies with fewer than 50 employees say EAPs aren’t available at their organizations, but they’d be interested. Forty percent said the same about mental and behavioral programs separate from an EAP.

Which mental health benefits do small employers offer?

Percentage of employers who offer each


<50 employees

50-99 employees

Flex work schedules



Paid sick/personal leave



Mental health resources via medical insurance plan



Onsite behavioral health counselors



Employee support groups



Behavioral health program separate from EAP






There’s also an employer-employee communications gap. While more than six in ten employers (61%) believe their organizations’ efforts to keep employees informed about their mental health resources are very or somewhat effective, 10% of workers at small businesses said they didn’t know about resources available to them and 12% said they were unsure what was covered.

A combined 22% of small business workers say they either don’t know what mental health resources are available to them through the workplace and don’t know what’s covered.

One key way to address this gap is through better manager training so they can help inform workers on their teams whom they suspect may be struggling with their mental health. Just under a third (30%) of small business employers agree their managers/supervisors are well-prepared to identify and respond to mental health needs in the workplace.


15 Dental Fundamentals. The Guardian Life Insurance Company of America. April 2022.

16 Ibid

17 Ibid

18 Mental Health by the Numbers. National Alliance on Mental Illness. 2020.

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