For groups with two to 50 people, some employers might consider moving to the health care exchange system, especially as the private exchanges come into play, says Ron Goldstein, founder and president of CHOICE Administrators, a developer and administrator of health care exchanges in Orange, Calif.

With private health care exchange systems, there are many valued-added benefits, such as stand-alone dental, vision and even chiropractic care, Goldstein says. State health care exchanges are also an option for employers, but the value-added benefits are not ready for the most part in the state health care exchanges. Goldstein believes that the value-added benefits will eventually come to the state health care exchanges because of the way the Affordable Care Act was built, though it may take some time.  

"You'll see probably two to three years from now that the states will be sound enough to go out and add those value adds, but the carriers themselves might be able to offer more value adds initially than the state exchanges," Goldstein says.