ICHRA

ICHRA Report Card for Carriers: who will win in 2022?

by Jack

The Individual Coverage Health Reimbursement Arrangement (ICHRA) is just over one-year old and steadily gaining in popularity as a benefits solution for employers. ICHRA allows employers to establish a tax-free reimbursement for employees and allows employees to pick an individual health plan that meets their needs. Employers love the predictability and employees love the choice: win-win. So which carriers are ready for this trend to continue to grow and which states have a leg up?

ICHRA is projected to grow significantly over the next few years and presents a great opportunity for insurance companies to expand coverage. The government projects approximately 10M employees will be covered by an ICHRA through their employer in the next 5-10 years.

A recent study by KFF and PBGH revealed that 48% of its respondents said they were "considerably or highly likely" to use an ICHRA to offer alternative coverage to employees.  

At Take Command, we’ve found that over 70% of our small employers moving to ICHRA are offering benefits for the first time—so ICHRA has a chance to cover more lives than before.

 

So how can insurance companies prepare for ICHRA? And which insurance companies are positioned to win in their market?

More than anything carriers need to be prepared to make operational adjustments to prepare for ICHRA.

ICHRA rules prevent private exchanges from limiting which plans are shown to employees during the shopping process, but insurance companies can stand out (or get left behind) based on four operational criteria:

  1. Do you appoint remote brokers? While ICHRA is inherently simple to understand, meeting the requirements takes expertise from an experienced broker or consultant that make revenue through commissions. In addition, employees used to group plans are used to being supported by brokers when they need help with their plan, replacing a lost card, etc and don’t want to call an insurance company directly.
  2. Do you accept electronic bulk enrollment files? Brokers and private exchanges supporting ICHRA need a way to efficiently enroll hundreds of employees at once. In most cases, the broker or exchange will have all of the information they need to complete enrollment for an employee after receiving the employee’s plan choice.
  3. Can brokers or private exchanges provide payment information (binder and recurring) for employees? Similar to above, private exchanges are coming up with unique payment solutions that enable ICHRA to look and function similar to a traditional group plan. Brokers and exchanges need to be able to provide payment information on behalf of employees.
  4. Do you offer off-exchange plans? Employees that choose a plan that costs more than their allowance will have to put in some of their own money to cover the difference. That difference can be tax-free when combined with a Section 125 payroll deduction but only for off-exchange plans (due to some ACA restrictions).

How do these operational things add up to influence an employee’s shopping decision?

Let’s look at an example. Below is a fictitious “screen shot” from a private exchange supporting an ICHRA enrollment. In this scenario, an employee named John is being provided $300/mo by his employer to choose a health plan.

Screen Shot 2021-07-12 at 3.50.46 PM

There are 35 plans in his area; a private exchange will have to show all of those options so pretend the screen scrolls down to list all of the options. In this case, John is choosing between two finalists—Bronze plans with similar price points and plan features from Insurance Companies A and B: Although the plans are very similar, Company A has taken the operational steps listed above and Company B has not.

What does this mean for John? A LOT! If John chooses the plan from Company A, he’s essentially done. The private exchange (and the broker) have the information needed to complete the enrollment for John and his family. The unreimbursed portion of the premium ($150 in this example) will be withheld on John’s paycheck tax-free and the entire amount will be paid to Company A by the employer on John’s behalf.

If John chooses the plan from Company B, he’ll have to complete enrollment on Company B’s website or through a state exchange. He will then have to provide proof of enrollment back to the entity managing the ICHRA (usually a screen shot or a receipt). John will have to provide his personal payment information to Company B and make his binder and recurring payments each month on his own—floating the cost until he is reimbursed by the ICHRA administrator.

In addition, the $150 unreimbursed portion of the premium comes out of John’s taxable income. It’s easy to see how Insurance Company A will get the lion’s share of enrollments compared to Company B because they were operationally ready for ICHRA.

From our experience at Take Command, our enrollment team saw employees willing to pay more to have convenience over known brand names, etc.

We haven’t even talked about plan designs and features yet which will also be important, but won’t matter to employees if they have to jump through hoops to enroll.

 

So which insurance companies are operationally ready for ICHRA?

In the table below, we summarize the ICHRA Operational Readiness for insurance companies based on our review of their current capabilities. We list insurance companies by state so they can think about two primary strategies:

  • Offense: Some insurance companies have the opportunity to be “first movers” for ICHRA in their state and position themselves to win an outsized share of the ICHRA market.

  • Defense: Some insurance companies will need to play catch up so they don’t lose additional market share to employers switching to the ICHRA model.

State Insurance Company ICHRA Readiness Appoint Remote Brokers Bulk Enrollment Payment Information Off-Exchange Plans Offered
AK Moda Health 0% No No No No
AK Premera BCBS of Alaska 50% Yes No No Yes
AL BCBS AL 50% No No Yes Yes
AL Bright Health Plan 75% Yes No Yes Yes
AR Ambetter 100% Yes Yes Yes Yes
AR Arkansas BCBS 50% No No Yes Yes
AR QualChoice 50% No No Yes Yes
AZ Ambetter 100% Yes Yes Yes Yes
AZ BCBS AZ 75% Yes  No Yes Yes
AZ Bright Health Plan 75% Yes No Yes Yes
AZ Cigna 75% Yes No Yes Yes
AZ Oscar 75% Yes No Yes Yes
AZ United Healthcare 0% No No No No
CA Anthem 75% Yes No Yes Yes
CA BlueShield of California 75% Yes No Yes Yes
CA Chinese Community Health 25% No No Yes No
CA Health Net 100% Yes Yes Yes Yes
CA Kaiser Permanente 75% Yes No Yes Yes
CA L.A. Care Health Plan 50% Yes No Yes No
CA Molina 50% Yes No Yes No
CA Oscar 75% Yes No Yes Yes
CA Sharp Health Plan 50% Yes No No Yes
CA Sutter Health Plan 25% Yes No No Yes
CA Valley Health Plan 50% Yes No Yes No
CA Western Health Advantage 50% Yes No No Yes
CO Anthem 75% Yes No Yes Yes
CO Bright Health Plan 75% Yes No Yes Yes
CO Cigna 75% Yes No Yes Yes
CO Denver Health Medical Plan 25% No No No Yes
CO Friday Health Plan 75% Yes No Yes Yes
CO Kaiser Permanente 75% Yes No Yes Yes
CO Oscar 75% Yes No Yes Yes
CO Rocky Mountain Health Plans 75% Yes No Yes Yes
CT Anthem 75% Yes No Yes Yes
CT ConnectiCare 75% Yes No Yes Yes
DC CareFirst BCBS 25% Yes No No No
DC Kaiser Permanente 25% Yes No No No
DE Highmark BCBS 50% Yes No No Yes
FL Ambetter 100% Yes Yes Yes Yes
FL AvMed 75% Yes No Yes Yes
FL Bright Health Plan 75% Yes No Yes Yes
FL Cigna 75% Yes No Yes Yes
FL Florida Blue 25% No No No Yes
FL Florida Health Care Plans 25% No No No Yes
FL Health First Health Plans 75% Yes No Yes Yes
FL Molina  50% Yes No Yes No
FL Oscar 75% Yes No Yes Yes
GA Alliant Health Plans 75% Yes No Yes Yes
GA Ambetter 100% Yes Yes Yes Yes
GA Anthem 75% Yes No Yes Yes
GA CareSource Just4Me 25% Yes No No No
GA Kaiser Permanente 75% Yes No Yes Yes
GA Oscar 75% Yes No Yes Yes
HI Kaiser Permanente 50% Yes No Yes Yes
HI HMSA 0% No No No No
IA Medica Insurance Company 75% Yes No Yes Yes
IA Oscar 75% Yes No Yes Yes
IA Wellmark BCBS of Iowa 0% No No No No
ID BlueCross of Idaho 50% No No Yes Yes
ID Mountain Health CO-OP 75% Yes No Yes Yes
ID PacificSource Health Plans 50% No No Yes Yes
ID Regence BlueShield of Idaho 75% Yes No Yes Yes
ID SelectHealth 50% No No Yes Yes
IL Ambetter 100% Yes Yes Yes Yes
IL BCBS Illinois 75% Yes No Yes Yes
IL Bright Health Plan 75% Yes No Yes Yes
IL Cigna 75% Yes No Yes Yes
IL Health Alliance 75% Yes No Yes Yes
IL MercyCare Health Plans 50% No No Yes Yes
IL Quartz 50% No No Yes Yes
IL WellFirst Health 25% No No Yes No
IN Ambetter 100% Yes Yes Yes Yes
IN Anthem 75% Yes No Yes Yes
IN CareSource Just4Me 25% Yes No No No
KS Ambetter 100% Yes Yes Yes Yes
KS BCBS of Kansas 50% No No Yes Yes
KS BlueKC 25% Yes No No No
KS Cigna 75% Yes No Yes Yes
KS Medica Insurance Company 75% Yes No Yes Yes
KS Oscar 75% Yes No Yes Yes
KY Anthem 75% Yes No Yes Yes
KY CareSource Just4Me 25% Yes No No No
LA BCBS of Louisiana 50% No No Yes Yes
LA CHRISTUS Health Plan 25% Yes No No No
LA Vantage Health 0% No No No No
MA AllWays Health Partners (aka Neighborhood Health Plan) 25% No No Yes No
MA BMC HealthNet 25% No No Yes No
MA BCBS of Massachusetts 50% No No Yes Yes
MA Fallon Health 50% Yes No Yes No
MA Harvard Pilgrim 50% Yes No No Yes
MA Health New England  25% No No Yes No
MA Tufts Health Plans 25% No No Yes No
MA United Healthcare 25% No No Yes No
MD CareFirst BCBS 50% Yes No No Yes
MD Kaiser Permanente 75% Yes No Yes Yes
MD United Healthcare 25% No No No Yes
ME Anthem 50% Yes No Yes Yes
ME Community Health Options 25% No No No Yes
ME Harvard Pilgrim 50% Yes No No Yes
MI Ambetter 100% Yes Yes Yes Yes
MI BCBS Michigan 75% Yes No Yes Yes
MI HAP 75% Yes No Yes Yes
MI McLaren Health Plan 25% Yes No No No
MI Meridian Choice 0% No No No No
MI Molina 25% Yes No No No
MI Oscar 75% Yes No Yes Yes
MI Physicians Health Plan  75% Yes No Yes Yes
MI Priority Health Plan  75% Yes No Yes Yes
MI Total Health Care USA 75% Yes No Yes Yes
MN BCBS Minnesota 75% Yes No Yes Yes
MN HealthPartners 25% No No No Yes
MN Medica Insurance Company 75% Yes No Yes Yes
MN PreferredOne 75% Yes No Yes Yes
MN Quartz 50% No No No Yes
MN UCare 0% No No No No
MO Ambetter 50% Yes No Yes No
MO Anthem 75% Yes No Yes Yes
MO Cigna 75% Yes No Yes Yes
MO Cox Health Systems Insurance Company 0% No No No No
MO Medica Insurance Company 75% Yes No Yes Yes
MO Oscar 75% Yes No Yes Yes
MO SSM Health Insurance Company 0% No No No No
MS Ambetter  25% Yes No No No
MS Molina 25% Yes No No No
MT BCBS Montana  75% Yes No Yes Yes
MT Montana Health CO-OP 75% Yes No Yes Yes
MT PacificSource Health Plans 50% No No Yes Yes
NC Ambetter 25% Yes No No No
NC BCBS North Carolina 50% No No Yes Yes
NC Bright Health Plan 75% Yes No Yes Yes
NC Cigna 75% Yes No Yes Yes
NC Oscar 75% Yes No Yes Yes
NC United Healthcare 25% No No No Yes
ND BCBS North Dakota 50% No No Yes Yes
ND Medica Insurance Company 75% Yes No Yes Yes
ND Sanford Health Plan 50% No No Yes Yes
NE Bright Health Plan  75% Yes No Yes Yes
NE Medica Insurance Company 75% Yes No Yes Yes
NH Ambetter 100% Yes Yes Yes Yes
NH Anthem 75% Yes No Yes Yes
NH Harvard Pilgrim  50% Yes No No Yes
NJ AmeriHealth 75% Yes No Yes Yes
NJ Horizon BCBS of New Jersey 75% Yes No Yes Yes
NJ Oscar 75% Yes No Yes Yes
NJ Oxford 25% No No No Yes
NM Ambetter 25% Yes No No No
NM BCBS New Mexico 75% Yes No Yes Yes
NM Friday Health Plan 75% Yes No Yes Yes
NM Molina 25% Yes No No No
NM Presbyterian Health Plan 75% Yes No Yes Yes
NM True Health New Mexico 75% Yes No Yes Yes
NV Ambetter 25% Yes No No No
NV Anthem 75% Yes No Yes Yes
NV Friday Health Plan  75% Yes No Yes Yes
NV Health Plan of Nevada 25% No No No Yes
NV Hometown Health  50% No No Yes Yes
NV SelectHealth 50% No No Yes Yes
NV Sierra Health and Life 50% No No Yes Yes
NY Aetna 0% No No No No
NY BCBS of Western New York 50% No No Yes Yes
NY BlueShield of Northeastern New York 50% No No Yes Yes
NY CDPHP 50% No No Yes Yes
NY EmblemHealth 50% No No Yes Yes
NY Empire BCBS 0% No No No No
NY Excellus  50% No No Yes Yes
NY Fidelis Care  0% No No No No
NY HealthFirst 0% No No No No
NY Independent Health 50% No No Yes Yes
NY MVP Health Plans 50% No No Yes Yes
NY MetroPlus Health Plan 0% No No No No
NY Oscar 75% Yes No Yes Yes
NY United Healthcare 0% No No No No
OH Ambetter 100% Yes Yes Yes Yes
OH Anthem 75% Yes No Yes Yes
OH AultCare Insurance 25% Yes No No No
OH CareSource Just4Me 25% Yes No No No
OH Medical Mutual  25% Yes No No No
OH Molina 25% Yes No No No
OH Oscar 75% Yes No Yes Yes
OH Paramount Insurance 0% No No No No
OH SummaCare 75% Yes No Yes Yes
OK BCBS Oklahoma 75% Yes No Yes Yes
OK Bright Health Plan 75% Yes No Yes Yes
OK CommunityCare 25% No No No Yes
OK Medica 75% Yes No Yes Yes
OK Oscar 75% Yes No Yes Yes
OK United Healthcare 0% No No No No
OR BridgeSpan Health Company 75% Yes No Yes Yes
OR Kaiser Permanente 75% Yes No Yes Yes
OR Moda Health 50% No No Yes Yes
OR PacificSource Health Plans 50% No No Yes Yes
OR Providence Health Plan 50% No No Yes Yes
OR Regence BCBS 75% Yes No Yes Yes
PA Ambetter 100% Yes Yes Yes Yes
PA Capital Blue Cross 75% Yes No Yes Yes
PA Geisinger 0% No No No No
PA Highmark BCBS 50% Yes No No Yes
PA Independence Blue Cross 75% Yes No Yes Yes
PA Oscar 75% Yes No Yes Yes
PA UPMC 75% Yes No Yes Yes
RI BCBS Rhode Island 75% Yes No Yes Yes
RI Neighborhood Health Plan of Rhode Island 50% No No Yes Yes
SC Ambetter 25% Yes No No No
SC BlueChoice Health Plan of South Carolina 75% Yes No Yes Yes
SC BCBS South Carolina 75% Yes No Yes Yes
SC Bright Health Plan  75% Yes No Yes Yes
SC Molina 50% Yes No Yes No
SD Avera Health Plans 50% No No Yes Yes
SD Sanford Health Plan 50% No No Yes Yes
TN Ambetter 25% Yes No No No
TN BCBS Tennessee 75% Yes No Yes Yes
TN Bright Health Plan 75% Yes No Yes Yes
TN Cigna 75% Yes No Yes Yes
TN Oscar 75% Yes No Yes Yes
TN United Healthcare 0% No No No No
TX Ambetter 100% Yes Yes Yes Yes
TX BCBS Texas 75% Yes No Yes Yes
TX CHRISTUS Health Plan  50% Yes No No Yes
TX Community Health Choice 0% No No No No
TX El Paso First Health Plans 0% No No No No
TX Firstcare Health Plans 0% No No No No
TX Friday Health Plans  75% Yes No Yes Yes
TX Molina  25% Yes No No No
TX Oscar  75% Yes No Yes Yes
TX Scott & White 75% Yes No Yes Yes
TX Sendero Health Plans 0% No No No No
UT BridgeSpan Health Company 75% Yes No Yes Yes
UT Cigna 75% Yes No Yes Yes
UT Molina 25% Yes No No No
UT Regence BCBS 75% Yes No Yes Yes
UT SelectHealth 50% No No Yes Yes
UT University of Utah Health Plan 75% Yes No Yes Yes
VA Anthem 75% Yes No Yes Yes
VA CareFirst BCBS 50% Yes No No Yes
VA Cigna 75% Yes No Yes Yes
VA Kaiser Permanente 75% Yes No Yes Yes
VA Optima Health 75% Yes No Yes Yes
VA Oscar 75% Yes No Yes Yes
VA Piedmont Healthcare 0% No No No No
VA United Healthcare 50% No No Yes Yes
VT BCBS Vermont 50% No No Yes Yes
VT MVP Health Plans 50% No No Yes Yes
WA Ambetter 25% Yes No No No
WA Asuris Northwest Health  75% Yes No Yes Yes
WA BridgeSpan Health Company  75% Yes No Yes Yes
WA Community Health Network of Washington  0% No No No No
WA Health Alliance 50% No No Yes Yes
WA Kaiser Permanente  75% Yes No Yes Yes
WA LifeWise Health Plan  50% No No Yes Yes
WA Molina  25% Yes No No No
WA PacificSource Health Plans 50% No No Yes Yes
WA Premera Blue Cross 75% Yes No Yes Yes
WA Providence Health Plan 50% No No Yes Yes
WA Regence BCBS 75% Yes No Yes Yes
WA Regence BlueShield 75% Yes No Yes Yes
WA United Healthcare 0% No No No No
WI Anthem  75% Yes No Yes Yes
WI Aspirus Arise Health Plan of Wisconsin  75% Yes No Yes Yes
WI Arise Health Plan  75% Yes No Yes Yes
WI Common Ground Healthcare Cooperative 75% Yes No Yes Yes
WI Dean Health Plan  25% Yes No No No
WI Group Health Cooperative 50% No No Yes Yes
WI Health Partners 50% No No Yes Yes
WI Medica Insurance Company 75% Yes No Yes Yes
WI MercyCare Health Plans 50% No No Yes Yes
WI Molina 25% Yes No No No
WI Network Health Plan  75% Yes No Yes Yes
WI Quartz  50% No No Yes Yes
WI Security Health Plan  75% Yes No Yes Yes
WI Together with Children's Community Health Plan  75% Yes No Yes Yes
WI Wisconsin Physicians SVC Insurance Corp 75% Yes No Yes Yes
WV CareSource Just4Me 25% Yes No No No
WV Highmark BCBS 50% Yes No No Yes
WY BCBS Wyoming 50% No No Yes Yes
WY Mountain Health CO-OP 50% No No Yes Yes

Which states are ready for ICHRA from a carrier preparedness standpoint?

We've put together a chart to demonstrate which states are positioned to win with ICHRA based on their carriers' level of readiness. 

 

State Overall ICHRA Readiness
AK 25%
AL 62.5%
AR 50%
AZ 66.7%
CA 58.3%
CO 68.75%
CT 75%
DC 25%
DE 50%
FL 63.8%
GA 70.8%
HI 25%
IA 50%
ID 60%
IL 53.13%
IN 66.7%
KS 66.67%
KY 50%
LA 25%
MA 34%
MD 50%
ME 41.67%
MI 60%
MN 45.83%
MO 50%
MS 25%
MT 66.67%
NC 65%
ND 58.33%
NE 75%
NH 75%
NJ 62.50%
NM 58.33%
NV 50%
NY 30.36%
OH 47.22%
OK 66.67%
OR 62.5%
PA 64.2%
RI 62.5%
SC 60%
SD 50%
TN 54.16%
TX 43.18%
UT 62.5%
VA 59.38%
VT 50%
WA 50%
WI 61.67%
WV 37.5%
WY 62.5%

 

 

See something not right? Want to learn how you can implement these changes?

We'd love to talk to you about ICHRA preparedness! Contact Emily@TakeCommandHealth.com and Mackenzie@TakeCommandHealth.com.

Last updated: 7/15/21

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Hi, I'm Jack! I wrote this blog to help people make smart health insurance decisions. I am a small business owner, a husband, and a dad to three boys, so I've seen firsthand how important understanding insurance decisions can be. As a co-founder of Take Command Health and a licensed health professional, I've been recognized as a leading expert on healthcare transparency and defined contribution arrangements (QSEHRA). I've been featured in the New York Times, Wall Street Journal, Dallas Morning News, Forbes and others. Learn more about me and connect with me on our about us page. Thanks!