\n This image provided by Take Command in June 2025 shows an example of options online for Individual Coverage Health Reimbursement Arrangements where a company’s employees can choose a health insurance policy.
\n AP\n <\/p>\n
A small, growing number of employers are putting health insurance<\/a> decisions entirely in the hands of their workers.<\/p>\n Instead of offering traditional insurance, they\u2019re giving workers money to buy their own coverage in what\u2019s known as Individual Coverage Health Reimbursement Arrangements, or ICHRAs<\/a>.<\/p>\n Advocates say this approach provides small companies that couldn\u2019t afford insurance a chance to offer something. It also caps a growing expense for employers and fits conservative political goals of giving people more purchasing power over their coverage.<\/p>\n But ICHRAs place the risk for finding coverage on the employee, and they force them to do something many dislike: Shop for insurance.<\/p>\n \u201cIt\u2019s maybe not perfect, but it\u2019s solving a problem for a lot of people,\u201d said Cynthia Cox, of the nonprofit KFF, which studies health care issues.<\/p>\n Here\u2019s a closer look at how this approach to health insurance is evolving.<\/p>\n What\u2019s an ICHRA?<\/strong><\/p>\n Normally, U.S. employers offering health coverage will have one or two insurance options for workers through what\u2019s known as a group plan. The employers then pick up most of the premium, or cost of coverage.<\/p>\n ICHRAs are different: Employers contribute to health insurance coverage, but the workers then pick their own insurance plans. The employers that use ICHRAs hire outside firms to help people make their coverage decisions.<\/p>\n ICHRAs were created during President Donald Trump\u2019s first administration. Enrollment started slowly but has swelled in recent years.<\/p>\n What\u2019s the big deal about ICHRAs?<\/strong><\/p>\n They give business owners a predictable cost, and they save companies from having to make coverage decisions for employees.<\/p>\n \u201cYou have so many things you need to focus on as a business owner to just actually grow the business,\u201d said Jeff Yuan, co-founder of the New York-based insurance startup Taro Health.<\/p>\n Small businesses, in particular, can be vulnerable to annual insurance cost spikes, especially if some employees have expensive medical conditions. But the ICHRA approach keeps the employer cost more predictable.<\/p>\n Yuan’s company bases its contributions on the employee’s age and how many people are covered under the plan. That means it may contribute anywhere from $400 to more than $2,000 monthly to an employee’s coverage.<\/p>\n How is this approach different?<\/strong><\/p>\n ICHRAs let people pick from among dozens of options in an individual insurance market instead of just taking whatever their company offers.<\/p>\n That may give people a chance to find coverage more tailored to their needs. Some insurers, for instance, offer plans designed for people with diabetes.<\/p>\n And workers can keep the coverage if they leave \u2014 potentially for longer periods than they would be able to with traditional employer health insurance plans. They likely will have to pay the full premium, but keeping the coverage also means they won\u2019t have to find a new plan that covers their doctors.<\/p>\n Mark Bertolini, CEO of the insurer Oscar Health, noted that most people change jobs several times.<\/p>\n \u201cInsurance works best when it moves with the consumer,\u201d said the executive, whose company is growing enrollment through ICHRAs in several states.<\/p>\n What are the drawbacks?<\/strong><\/p>\n Health insurance plans on the individual market tend to have narrower coverage networks than employer-sponsored coverage.<\/p>\n It may be challenging for patients who see several doctors to find one plan that covers them all.<\/p>\n