Small Business

How to shop for an ICHRA compliant plan

by Lauren

With Individual Coverage Health Reimbursement Arrangements (aka ICHRAs) being new to the marketplace and available to businesses of all sizes, it’s likely that you may find yourself shopping for individual insurance for the first time after historically accepting the group health insurance plan provided through your employer each year without a second thought.  

Navigating the insurance marketplace can be overwhelming and confusing, but it’s a significant decision, and we’re here to help cut through the jargon so you can make the smartest decision for you and your family.  

Where do I find an ICHRA compliant plan? 

 

First things first, to be eligible for ICHRA reimbursements, you and any dependents need to be enrolled in an individual health insurance plan that meets Minimum Essential Coverage (MEC). When shopping for an individual plan, you'll want to look for the words individual, bronze, silver, gold, or platinum in the plan name- those are good indicators that you are looking at a plan that meets MEC and is compliant with ICHRA. You can search for a plan and compare your options at takecommandhealth.com, our own data-driven individual health insurance shopping platform, or you can shop plans off exchange (directly from a private insurance carrier or broker).  Medicare plans are compliant as long as you have Medicare Part A & B or Medicare Part C.  

What’s with the metal tiers? 

The primary difference between the different metal tiers is the percentage of costs that are covered by the plan. On one end of the spectrum, bronze plans have lower premiums, higher deductibles, and higher max-out-of-pocket costs. On the other side, platinum plans have much higher premiums, lower deductibles, and lower max-out-of-pocket costs. The metal tiers have nothing to do with the quality of care or coverage – they are simply about consumer preference regarding costs. 

To make your decision, it really comes down to how much you expect to use your health plan, and what you are comfortable with from a financial perspective. The lower the metal level, the lower the known cost (premium) but the higher the potential unexpected cost (max-out-of-pocket), and vice versa. When you enter your doctors, prescriptions, and conditions on the Take Command Health website we use this information to help estimate your costs to give you the most complete picture of what you can expect with each plan. We tend to recommend bronze and silver plans in most situations, and generally only recommend gold and platinum plans in specific scenarios. Does all this lingo make your head spin? Check out this blog post that should hopefully clarify all the common insurance terminology you’re likely to run across.  

 

Any plans that aren’t compliant that I should avoid?  

Sharing plans like Medi-Share, Samaritan Ministries, and Liberty Health Share (among others) have grown increasingly popular over the last few years, but you’ll want to steer clear of these- they aren’t compliant with ICHRA. A recent executive order mentioned the possibility of sharing plans being considered as qualified medical expenses, but we’ll have to see how the specifics pan out- check back here for updates once we know more! Short-term, limited duration insurance (STLDI) plans and coverage for vision & dental only will also not qualifyThe reason these plans aren’t compliant is that they don’t meet MEC requirements.  

 

When can I enroll in individual health insurance coverage? 

 Anyone can enroll in or change their individual health insurance coverage during the individual market’s annual open enrollment period from November 1 through December 15. (Some state exchanges may provide additional time to enroll.) If your ICHRA starts on January 1, you (and your family members) should enroll in individual health insurance coverage during that open enrollment timeframe. 

If your ICHRA starts on a date other than January 1 or if you are a new hire being offered the ICHRA mid-year, you can enroll in a plan outside of open enrollment using what is called a “special enrollment period” (more on that here).  If you qualify for a special enrollment period, make sure you enroll on time! You’ll have 60 days from the day your HRA starts to secure your coverage.  

 

Have questions along the way? Chat with us online or contact us at support@takecommandhealth.com. We’d be happy to help you navigate your options and feel confident that you have an ICHRA compliant plan. 

Picture of Lauren

Hi, I'm Lauren! I wrote this blog because I know from personal experience how confusing it can be to navigate healthcare and I’m passionate about bringing clarity and simplicity to the process. After graduating from A&M, I worked for Southwest Airlines before deciding to stay home with my then infant son. I spent countless hours as a new mom(on little sleep) trying to choose an individual insurance plan and manage healthcare costs for our family, and that’s when I stumbled upon Take Command Health. Fast forward three years and I’m now a Client Success Manager for them part-time(when I’m not chasing around two toddlers).