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Workers who are using their employers' cash to shop for health coverage do consider factors other than their share of the premiums, according to a plan administration firm.
SureCo — a company that helps workers sign up for insurance through individual coverage health reimbursement arrangement plans — found that 81% of the workers chose silver plans with mid-level benefits or gold plans with rich benefits.
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Just 18% of the ICHRA users tried to minimize their out-of-pocket spending on premiums by choosing low-benefit-level bronze plans.
SureCo based those figures on an analysis of enrollment data for ICHRA plan participants who used its systems to sign up for coverage from January 2021 through February 2025.
Oscar, a health insurer that wants to sell coverage to ICHRA users, presented the findings of the analysis.
The SureCo new analysis is part of a small collection of studies that show how cash-for-coverage plans work in the real world.
Under current federal rules, a gold-level plan covers about 80% of the value of a standard package of health benefits.
A silver plan covers about 70% of the value of the standard package, and a bronze plan covers about 60%.
ICHRAs: Employers have been looking for legal ways to provide cash that workers can use to buy their coverage for decades.
The ICHRA program and a similar program, the qualified small employer health reimbursement arrangement, now let employers set up plans that let workers use employer cash to pay for individual major medical coverage.
More study details: SureCo said it also found other signs that ICHRA users were considering quality and value as well as current out-of-pocket premium costs when choosing coverage.
Half showed they were thinking about issuer quality by filtering plan options list by carrier.
More than 50% said they had thought about whether their own health care providers were in a plan's network.
What it means: One concern about cash-for-coverage programs has been whether the current U.S. individual health insurance market offers enough high-quality plans to satisfy workers used to employer plans with rich benefits and big provider networks.
Related: Small employers need better ICHRA options, said analyst at Senate Finance hearing
ICHRA skeptics have also wondered whether individual consumers understand health coverage options well enough to shop for coverage based on factors other than out-of-pocket premium costs.The new SureCo analysis could help frame discussions about how well ICHRA users can choose plans based on factors other than the monthly premium bills.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
