Amid instability in the Affordable Care Act marketplaces, proponents of ICHRA have suggested that these models could help support risk pools. A new survey from the HRA Council adds to the body of evidence on the matter.
The council, a nonpartisan organization that pushes for expanded coverage options, released its latest look at trends around individual coverage reimbursement arrangements, or ICHRA, and found that a growing number of larger employers are considering it as an option.
The larger employee base from these firms could bring more younger, healthier individuals into the market, adding greater stability to the risk pools that would be felt on the exchanges, according to the report.
Based on data from the council's 17 member organizations, there were about 6,600 employers offering an ICHRA in 2025. That nearly doubled to 12,700 as of January 2026. The report found 109% growth among employers with 500 to 999 employees. ICHRA adoption among firms with more than 1,000 employees was up by 178%.
ICHRAs have often been posited to date as a solution for small businesses that may otherwise struggle to offer coverage. But strong and ongoing growth among larger employers is critical to bolstering the broader individual market risk pool, said Robin Paoli, the council's executive director, in an interview with Fierce Healthcare.
"As these bigger employers adopt, then that risk pool gets even stronger because more people are coming in," she said.
The survey found that more than half of enrollments, both on- and off-exchange, are among people under the age of 45.
In addition to growing interest in ICHRAs, the report found that when people are offered it as an option, many choose to "flex up" to a higher-tier of plan and add their own money on top of the stipend. In an ICHRA, the employer offers workers a set amount to purchase coverage on the exchanges.
The analysis found that the median allowance offered to employees was $459 per month, while the median premium selected was $567. The median amount that individuals added to their employer contribution was $105.
Employees showed a preference for silver- or gold-tier plans, the study found, and this is particularly true among younger enrollees. For example, in a case study that the council has been tracking, a couple knowing that they planned to have a child flexed up to a gold plan to secure broader coverage ahead of the baby's birth, Paoli said.
"They're so happy that they got to do that, that they got to personalize what they wanted," she said.
One of the touted benefits of the ICHRA model is that it allows individuals or families to choose the coverage that best meets their specific needs, and the study bears out that patients are making those choices through this trend toward flexing up to higher-tier coverage, she said.
Beyond the trend toward greater adoption among larger employers, ICHRA continues to offer an on-ramp to coverage for small businesses, the survey found. More than two-thirds of the small employers offering an ICHRA in 2026 had no benefits available before, while the remaining third made the shift from a complex small group market.
The HRA Council is also tracking a trend of small businesses first embracing a qualified small employer health reimbursement arrangement, or QSHERA, before transitioning to ICHRA, Paoli said.
"They realize, 'ICHRA may be more flexible for us. ICHRA may be a better fit as we grow,'" she said, "and so in year two or three, you'll see people go from a QSEHRA to an ICHRA."