Beyond the one-size-fits-all solution: how ICHRA empowers employees and employers

Alan Silver is President of ICHRA at Ambetter Health Solutions, the market subsidiary of Centene.

Business leaders are facing a pivotal moment. Rising costs, workforce fragmentation and changing employee expectations are challenging the status quo of employer-sponsored insurance, driving the need for sustainable and scalable solutions. Individually covered health care reimbursement arrangements, or ICHRA plans, are gaining ground.

This isn’t just a trend: it’s a transformative approach to benefits design that aligns with modern workforce realities while preserving affordability and choice. For employers, this is an opportunity to rethink how we create value. For political decision-makers, it presents a convincing reform project.

For decades, our country has strived to provide affordable, accessible and relevant health care. Today’s workforce spans four generations, each with distinct needs, expectations and financial realities. However, today, most employees are fortunate to be able to choose between a handful of universal plans.

Instead, imagine a workplace where a new Gen Z hire, a millennial parent dealing with child care, and a seasoned baby boomer executive all find a health plan that fits their unique life stage, their family’s needs, and their personal priorities. This is the enabling reality that ICHRA unlocks. It represents a fundamental paradigm shift, finally placing choice and control directly in the hands of the individual and providing businesses with a dynamic solution for a multi-generational, multi-geographic workforce.

The ICHRA is an employer-sponsored account that allows employers to reimburse employees for individual health insurance premiums and qualified medical expenses. Rather than offering a single, traditional group health plan, employers make a defined contribution and employees use those funds to purchase individual coverage that best fits their unique needs, family situation and local market. It is a flexible, transferable and empowering departure from traditional group benefits, truly putting the individual at the center of their healthcare decisions.

ICHRA represents a clear evolution in employee benefits design, and the momentum is undeniable. At the state level, legislatures like Indiana’s have passed employer tax credits to encourage adoption of ICHRA. At Centene, we put this vision into practice by introducing an ICHRA program for Indiana employees. By starting with a targeted segment of our workforce, we are able to thoughtfully implement the model, gather employee feedback in real time, and refine the experience to ensure it meets their needs in a meaningful way.

Nationally, the U.S. House and Senate last month introduced the CHOICE Arrangement Act that would codify ICHRA into law, providing long-term stability and new flexibilities for employers and employees. Congress’ passage of this legislation could trigger one of the most significant changes to health insurance in decades.

The healthcare industry is at a critical inflection point. ICHRA is more than just a new benefits tool, it’s a clear signal of where employer-sponsored coverage is headed: toward greater personalization, greater flexibility, and greater employee accountability. As more states and federal lawmakers adopt this model, the opportunity to lead, rather than just follow, now presents itself.

Implementing any significant change in healthcare, especially if it involves personal benefits, requires careful navigation. We know that change is not easy. Health care is deeply personal and any change in how people access it can feel uncertain. This is why active listening, continuous learning and strong employee support are paramount.

We invite our industry peers to engage in this evolving landscape, and we hope employers will explore how ICHRA can empower their own workforce. Together, we can collectively reimagine what health care can benefit in the 21st century.