Should you provide

health insurance?

It is imperative that everyone have health insurance. Given this, providing healthcare will attract some of the best talent and can be a “make or break” attribute for certain candidates. Undoubtedly, making sure your nanny is covered with quality insurance is a benefit for everyone involved. As a care provider for your children, it is in the family’s best interest to ensure their nanny has adequate healthcare coverage prior to hiring him/her. Regardless of their health history, nannies are around small children and need to ensure their personal health is always good. In some situations, highly qualified, experienced nannies will require health insurance options as part of their employment package. According to the International Nanny Association, 17% of all nannies receive some form of employer-paid health insurance. This included 7% who received full health insurance coverage paid by their employers, and 10% who were provided with partially paid health insurance coverage. 

 However, providing health insurance to in-home childcare providers is not required and adds significant additional expense. Luckily, there are several affordable options to consider. 

Regardless of their health history, nannies are around small children and need to ensure their personal health is always good.

Options for Nanny Insurance 

Healthcare has become a part of negotiating and onboarding nanny candidates. Various health insurance plans can give candidates various coverage and contribution options. Providing multiple options allows the nanny to choose what type of insurance he/she requires and if there are any additional coverage needs (for dependents or spouses, etc…). Some current options include: 

Affordable Care Act: Individuals can now purchase their own private insurance policies through the Affordable Care Act (ACA), which includes subsidies that help pay monthly premiums. The ACA also allows employer contributions toward a health insurance policy to be considered a non-taxable compensation. This means that neither party is taxed if you employ only a single nanny. It becomes a win/win situation for both the nanny and the employer. 

Existing student or family plan. If a candidate is less than 26 years old, he or she may be eligible to remain listed as a dependent on their parent’s family plan. Also, if the candidate is currently a student, he or she may have access to significantly discounted student health insurance plans offered through their college or university. 

A spouse’s healthcare plan. Some candidates may already be covered through their spouse’s plan, if married. This can significantly reduce their need for comprehensive healthcare, but a candidate may still need some supplemental insurance options.

Temporary or short-term health insurance policies. These policies require renewal every six months to a year and tend not to cover pre-existing conditions, but tend to be more affordable. 

Catastrophic insurance. This type of policy does not include many day-to-day health expenses for treatments of things such as colds or other non-life-threatening conditions, it would cover significant problems like a car accident or hospitalization. These plans also tend to be relatively cheap, but usually have high deductibles associated with them. 

Online insurance. There are a host of online options popping up such as, Oscar Health and Health Net, that offer affordable plans tailored to an individual's unique needs. 

Discussing Insurance With Your Nanny 

Before employing a child care provider, you should sit down and discuss insurance options with the candidate. Some candidates may have several options to attain health insurance coverage including through their school, from their spouse, or as part of a dependent within a family depending on age. In addition, some candidates may be willing to cover health insurance independently and/or may have been covering their own health insurance in their previous position. It is good to find out what their current situation is and how flexible they are. During reference calls, asking about health care coverage can be a great way to determine options that have worked for the candidate in the past. 

Please take note: as a prospective employer, you cannot ask about specific medical conditions. It is generally best to present options, discuss general preferences, and allow the candidate to perform their own research to see what meets their specific needs.

Here are few points to discuss with your candidates:

Previous Insurance plan: Your nanny may hold an existing insurance coverage that he/her prefers and has established care providers within the network of their existing plan. If this is the case, it would be good to understand the requirements of the candidate and the cost of their current plan to inform the viability of options under consideration. If there are certain physicians or specialists that are preferred, they likely take multiple forms of insurance, which can be verified in advance of a switch. There also may be certain protocols around prescription coverage or other specific coverage items that should be addressed. 

Independent Insurance: Does your would-be nanny currently possess independent health insurance through a private plan or their spouse? If they do and are willing to maintain their existing insurance, then this will likely reduce your obligation to provide comprehensive coverage. However, a discussion with the candidate is still warranted to determine if additional coverage is desired or needed.  

Specific needs: Does the candidate have specific needs, such as prescription coverage or specialty provider coverage? Also, do they have dependents that need coverage?

Paying for Your Nanny’s Insurance

If you have opted to pay for your nanny’s health insurance, then you will need to decide how you want to cover the premiums. Depending on your negotiation with your nanny candidate, some employers opt to reduce annual income to cover health insurance premiums, creating a net neutral annual compensation plan. Other employers will cover health insurance premiums on top of the agreed-upon compensation for childcare, enhancing the total package. 

Some employers opt to pay the insurance company directly, and others choose to provide compensation directly to the nanny for purposes of health insurance premiums. There are pros and cons to both and the tax consequences are handled differently:

Paying the insurance company directly:

  • Can ensure insurance is maintained and current

  • Provides direct expenses trail for audit purposes

  • Can be recognized as tax free compensation

Paying the nanny to cover premiums: 

  • Can be included directly in paycheck, limiting the number of payments that are made each month

  • Can be blended with total compensation and viewed as reducing compensation to pay for healthcare premiums

  • Provides additional compensation flexibility to the nanny

Health Savings Accounts (HSA) for your Nanny

Depending on the type of health insurance your nanny has, the deductible could be high. Such out-of-pocket expenses can create a burden when needed in a lump sum in the case of an accident. Your nanny can set aside the funds required for the deductible on a pre-tax basis through a Health Savings Account and consider it a part of the health insurance plan each year. If the HSA is not fully utilized, then he/she can roll it into the next year. Saving money is often hard, but Health Savings Accounts allow your childcare provider to set aside funds on a pre-tax basis and provides needed funds to meet deductibles.

Tax Credits Help Pay for Insurance 

If you have opted to pay for or contribute to the cost of your nanny’s insurance, then there are tax credits that can be beneficial. The credit, known as the Health Insurance Tax Credit for Small Employers is offered if you purchase your nanny’s policy through the Small Business Health Options Program (SHOP) The credit can only be obtained if you pay for at least 50% of the premium and your nanny’s wage is less than $50,000 per year. The credit is approximately 50% of your contributions to your nanny’s plan. However, federal tax laws remain in a constant state of fluctuation so always confirm tax implications with your accountant. 

Don’t Forget the Cost of Prescriptions

When building a health insurance plan with your nanny, you should both look closely at prescription coverage. Many policies cover prescriptions, but some do not. The cost of pharmaceuticals has risen significantly in the last decade so making sure that your nanny can afford the expense is imperative. This may mean purchasing a more expensive plan. An HSA account can also help with these out of pocket expenses.  

No-No of Employer Insurance

According to the International Nanny Association, the federal government has ruled that nannies are not independent contractors but considered to be employees of the family. If you already own a business, you might be tempted to add your nanny to your employer's insurance plan, but this is a big ‘no-no.’  It is illegal to place a household employee on your company’s insurance plan if that person is not employed by the company.  

Undoubtedly, when it comes to exploring health insurance plans for your nanny, it pays to be creative and to consider your many options. What works for one nanny’s unique situation might not work as well for another so you need to sit down and discuss what type of health insurance your nanny requires and try to consider how you can contribute. In recent years, health insurance for nanny’s has become a significant bargaining chip that cannot be overlooked by either side. 


Most corporate jobs include a defined structure for salary and benefits like health and life insurance, paid vacation and sick time, company stock options, 401K (with matching), and more.  Many businesses also have policies in place concerning annual bonuses to coincide with company (and employee) successes over the course of the year.

“While a nanny is not a corporate employee, these benefits can make a substantial difference in their lives and their integration into the family unit.”

While a nanny is not a corporate employee, these benefits can make a substantial difference in their lives and their integration into the family unit. Since your nanny will become an integral part of your household, and in many cases, a beloved member of the family, you will likely want to do all you can to ensure that your nanny feels appreciated.

While the potential for annual bonuses may not come up during the interview process when discussing pay and extras like expense reimbursement and vacation time, it’s something you should definitely consider, especially if you’re happy with the service your nanny provides.  Do you really need to offer your nanny bonuses?  Here are a few things to think about:

Do Bonuses Matter?

The answer is a resounding yes—bonuses absolutely matter.  In any job, a bonus is an indicator of performance, signifying that an employee has met or exceeded expectations.  While employees may not count on bonuses, they certainly appreciate them. This is not just because of the extra cash, but because the bonus shows that an employer recognizes their effort and resultant successes.

Your nanny should be a critical component of your daily family life and most nannies provide several valuable services.  Above and beyond caring for your children, which includes supervision, cooking meals, doing laundry, light housekeeping, and often chauffeuring, they also help to provide a loving and stable home.

In addition, many nannies are an integral part of an organized home.  They may provide some amount of personal assistant-type services, such as booking appointments, grocery shopping, and travel, just for example.  In many cases, their services go far beyond what is expected in the average office job. For these reasons, you should strongly consider a bonus to show your appreciation.

Why Offer Bonuses?

Your nanny is a professional, likely with significant education and experience in the field of childcare.  In most professional settings, bonuses are expected for outperformers and in the field of childcare, an annual bonus is fairly customary. 

Bonuses do more that just show you appreciate your nanny and respect his/her professionalism and performance.  They provide additional income that your nanny may rely on.  

In addition, high quality nannies are usually in competitive situations and may often be approached or recruited by others. If they feel appreciated and well compensated, you are more likely to be able to retain them over the long term.  A qualified nanny who loves your kids and is loved in return is an ideal situation worth attention and effort.

Reasonable Bonus Amount

A customary bonus for a nanny is generally one to two weeks of pay, but can go all the way up to 10% of salary. This can also be contributed as paid vacation, contributions to healthcare benefits, or educational expenses.  It’s a good idea to discuss possible options with your nanny to find out what he/she prefers.  

There are many factors affecting bonus amounts including:

Overall Performance: Performance should be the main factor in deciding if and how much to bonus your nanny.  If you are happy with your nanny, he/she is an eager and committed member of the family, then definitely show your appreciation in the amount you bonus. If he/she is not performing well in certain areas, that should be communicated. It is important that your nanny understands your perception of his/her performance, so there are no surprises when it comes to bonuses. 

Salary: Naturally, the amount of salary your nanny earns will affect the amount of his or her bonus as a percentage of pay or weeks of salary.  The more a nanny earns, the more their bonus, both from an actual dollar amount as well as a percentage of salary.

Time: A nanny who has been with a family longer should be bonused more than a newer nanny.  If you’ve managed to retain your nanny for a few years, consider increasing the annual bonus as a way to reward outstanding performance and reflect the appreciation and affection you feel for this essential member of your household.

Number of Children: The number of children in the household is a major factor.  If you have another child during the course of the year, this significantly increases your nanny’s duties. It will likely increase his or her salary, making an increased bonus appropriate.  You also need to consider the amount of time your nanny spends with the family.  A live-in nanny is often on call and may spend most of his/her time with the family, thus earning a larger bonus than a live-out nanny that is on a relatively set schedule.

Above and Beyond: Things like taking the kids for the weekend, or attending after hours events and celebrations, or introducing new techniques, doing research on specific challenges and helping the family in unexpected ways are all factors in considering a bonus. If a nanny travels with the family without charging overtime for extra babysitting at night, etc…, then it is worth considering when determining the total bonus amount. 

 A Note on Taxation

Any wages, including bonuses, are considered taxable income, even if you pay in cash.  This means you can and should include the amount in your own annual tax filing and you should advise your nanny to note it as income in his/her tax filing to avoid any trouble with the IRS.

Lest you think you can simply give your nanny a tax-free gift in lieu of a bonus, think again.  Because your nanny is your employee, any item of cash value is deemed compensation, and is therefore taxable.  If you wish to avoid taxation, you could choose to pay directly for schooling, medical expenses, health insurance, a cell phone, or other tax-free gifts instead of offering cash as a bonus, but considering your nanny may rely on that extra cash around the holidays, you may just want to add it to his/her final check each year, regardless of taxation.