Despite efforts to lower the cost of health care, small businesses are still struggling to cover the expense.

According to the U.S. Small Business Administration, small businesses pay premiums that are 18% higher on average than large businesses pay for the same coverage. Whats more, the SBA says small businesses have higher administrative costs to set up and maintain the plans and less bargaining power in negotiating with insurance companies.

On top of that, health-care reform, which was supposed to save small businesses money, hasnt helped, according to John Cerasani, president of insurance brokerage Northwest Comprehensive. The fact of the matter is health-care reform didnt do anything to address the rising costs small business owners have, he says.

Given these challenges, here are four ways to save on rising health-care costs.

Shop Around

A common misconception among small business owners is that once they take out health insurance they are locked in for a period of time. But according to Anthony Lopez, small business consumer specialist at eHealthInsurance, health insurance can be a month-to-month expense, which means you can change plans at any time.

Theres a lot of different options, says Lopez. He says to shop around at least once every six months to make sure you are saving as much as possible.

Offer High Deductible Plans

These plans have lower premiums, but require the plan holder to pay a higher out of pocket deductible, which could motivate your employees to take better care of themselves.

High deductible health plans put the onus more on employees to take care of themselves in terms of managing expenses and costs, says Cerasani of Northwest Comprehensive. While high deductible plans may face resistance at big companies, Cerasani says small businesses are increasingly turning to high deductible plans as a way to offset costs.

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Four Ways to Save on Health Insurance