What is the Individual Coverage HRA?
An Individual Coverage Health Reimbursement Arrangement (ICHRA) is a modern way for employers to provide health benefits. Instead of paying for a traditional group plan, you set a monthly, tax-free allowance for each employee. Your team then uses those funds to choose their own ACA Marketplace or private health insurance plan.
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What is the
Affordable Care Act?
The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive health care reform law enacted in March 2010. It aims to make affordable health insurance available to more people, expand the Medicaid program, and support innovative medical care delivery methods to lower health care costs. Under the ACA, millions of previously uninsured individuals now have access to quality health care.
Who Qualifies For ICHRA Coverage?
To be eligible to enroll in health coverage through the Health Insurance Marketplace, you must:
Live in the United States
Be a U.S. citizen or national (or be lawfully present)
Not be incarcerated
Any W-2 employee offered an ICHRA allowance by their employer can shop for an ACA Marketplace or private health plan. Employees must live in the U.S., ne lawfully present, and not be incarcerated.
How Employees Enroll in a
Health Insurance
Marketplace Plan
Once your business sets up an ICHRA, employees can enroll in their chosen health plan through the ACA Marketplace or directly with carriers. We'll guide them step by step.
1. Visit this page to find your state's Health Insurance Marketplace.
2. Follow your state’s specific enrollment instructions.
During the enrollment period, you can:
Choose a plan for the first time
Continue with your current plan
Make changes to your current plan
Choose a new plan to replace your current one
Note: If you experience a life event or your household income is below a certain amount, you may qualify for a special enrollment period.
Who Qualifies?
To be eligible to enroll in health coverage through the Health Insurance Marketplace, you must:
Live in the United States
Be a U.S. citizen or national (or be lawfully present)
Not be incarcerated
There is no income limit to use the Health Insurance Marketplace. Special patient protections under the ACA ensure that insurers cannot refuse coverage based on gender or a pre-existing condition, there are no lifetime or annual limits on essential health benefits, and young adults can stay on their family's insurance plan until age 26.
How to Enroll in a
Health Insurance
Marketplace Plan
Enrollment in a Health Insurance Marketplace plan can be done during the annual open enrollment period or a special enrollment period triggered by life events like moving or having a baby. Here’s how to get started:
1. Visit this page to find your state's Health Insurance Marketplace.
2. Follow your state’s specific enrollment instructions.
During the enrollment period, you can:
Choose a plan for the first time
Continue with your current plan
Make changes to your current plan
Choose a new plan to replace your current one
Note: If you experience a life event or your household income is below a certain amount, you may qualify for a special enrollment period.
Types of Plans
ICHRAs don't limit employees to one plan. Instead, they can choose the plan level that matches their budget and care needs.
The Health Insurance Marketplace offers a range of plans categorized into four metal tiers: Bronze, Silver,
Gold, and Platinum. Each tier represents a different level of cost-sharing:
Bronze Plans
Lowest premiums
Highest out-of-pocket costs
Suitable if you want to pay lower premiums but higher costs when you need care
Silver Plans
Moderate premiums and out-of-pocket costs
Eligible for extra savings if you qualify for cost-sharing reductions
Gold Plans
High premiums
Low out-of-pocket costs
Ideal if you expect to need frequent care
Platinum Plans
Highest premiums
Lowest out-of-pocket costs
Best if you need a lot of care and can afford higher monthly premiums
More Options...
ICHRA funds aren't limited to one network type — employees can choose HMO, PPO, POS, or EPO depending on what works best for them.
Preferred Provider Organization (PPO) Plans
PPO plans offer flexibility in choosing healthcare providers. You can see any in-network provider without a referral, but out-of-network care will cost more.
Point-of-Service (POS) Plans
POS plans combine features of HMO and PPO plans. You need a referral from a primary care physician to see specialists, but you can receive care out-of-network at higher costs.
Health Maintenance Organization (HMO) Plans
HMO plans require you to use in-network providers and get referrals from a primary care physician. These plans typically have lower premiums and out-of-pocket costs.
Exclusive Provider Organization (EPO) Plans
EPO plans only cover in-network care except in emergencies. No referrals are needed to see specialists, making them more flexible than HMOs but without out-of-network benefits.
Types of Plans
The Health Insurance Marketplace offers a range of plans categorized into four metal tiers: Bronze, Silver, Gold, and Platinum. Each tier represents a different level of cost-sharing:
Bronze Plans
Lowest premiums
Highest out-of-pocket costs
Suitable if you want to pay lower premiums but higher costs when you need care
Silver Plans
Moderate premiums and out-of-pocket costs
Eligible for extra savings if you qualify for cost-sharing reductions
Gold Plans
High premiums
Low out-of-pocket costs
Ideal if you expect to need frequent care
Platinum Plans
Highest premiums
Lowest out-of-pocket costs
Best if you need a lot of care and can afford higher monthly premiums
More Options...
Preferred Provider Organization (PPO) Plans
PPO plans offer flexibility in choosing healthcare providers. You can see any in-network provider without a referral, but out-of-network care will cost more.
Point-of-Service (POS) Plans
POS plans combine features of HMO and PPO plans. You need a referral from a primary care physician to see specialists, but you can receive care out-of-network at higher costs.
Health Maintenance Organization (HMO) Plans
HMO plans require you to use in-network providers and get referrals from a primary care physician. These plans typically have lower premiums and out-of-pocket costs.
Exclusive Provider Organization (EPO) Plans
EPO plans only cover in-network care except in emergencies. No referrals are needed to see specialists, making them more flexible than HMOs but without out-of-network benefits.
More Info
Important Questions
How much does an ICHRA cost my business?
You choose the budget. Employers set a monthly allowance for each employee, and that amount is completely tax-free. No surprise renewals or rate hikes.
Do employees get to pick their own plan?
Yes! Each employee can choose any ACA Marketplace or private plan that best fits their needs and family situation.
Is an ICHRA ACA compliant?
Yes. ICHRAs meet ACA requirements when the employer's contribution is considered "affordable", making it a safe alternative to group health insurance.
What size businesses can use ICHRA?
ICHRAs work for businesses of any size — from small startups to large companies. Any employer with at least one W-2 besides the owner can offer an ICHRA. They're especially valuable with small businesses that have 2-50 employees, but they scale just as well for larger companies with hundreds of employees.
How do I set one up?
It's simple. We'll guide you through choosing your contribution amount, setting up employee classes (full-time, part-time, seasonal, etc.), and helping employees select their coverage.
More Info
Important Questions
What Should I Budget for Health Insurance?
You should choose the Bronze or Silver plans if you need to save money, or the Gold or Platinum plans if you have a larger budget and expect to need frequent healthcare services.
Can I Work with My Preferred Doctor?
Yes absolutely, but please ensure that your preferred doctors and hospitals are in-network to avoid high out-of-pocket costs.
Prescription Drug Needs
Choose a plan that effectively covers your medication requirements. If you are unsure which plan to choose, you can schedule a free consultation call with one of our experts below.
I Need Help Paying for Health Insurance
Premium subsidies are available for incomes between 100% and 400% of the federal poverty level; you can check your eligibility on the Health Insurance Marketplace.
How do I Sign Up?
For more detailed information and personalized assistance, schedule an appointment with me today. I can guide you through the process, help you understand your options, and ensure you find a plan that meets your needs and budget. Schedule an appointment now to get started on securing your health insurance coverage.
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BrightGuard Benefits is committed to serving you at the highest level with all your Healthcare needs.
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BrightGuard Benefits is committed to serving you at the highest level with all your Healthcare needs.
National Producer Number: 21337265
Company
Directories
Legal