Centene is putting its money where its mouth is when it comes to individual coverage health reimbursement arrangements.
The managed care giant is transitioning more than 700 Indiana-based employees to ICHRA in 2026, becoming one of the most notable endorsements yet of the growing health benefit model by a major carrier.
“We’re really excited about what’s happening in Indiana and what it means for the future of ICHRA in other states and for other companies,” Alan Silver, president of Centene’s ICHRA business, told Becker’s. “It’s important to show that we believe in this so much that we’re having our own employees use it too.”
ICHRAs allow employers to provide tax-advantaged reimbursements for employees to purchase individual health coverage, either on or off the ACA marketplace, rather than offering a traditional group plan. Centene, the largest ACA insurer by enrollment with more than 5 million members, has been vocal about its strategy to expand the coverage model to employers.
The latest move affects all Centene employees with worksites in Indiana, who are currently navigating open enrollment for the new arrangement. Employees outside Indiana will remain on the company’s group health plan.
In an industry first for insurance leadership, Centene CEO Sarah London will also enroll in individual market coverage for 2026, though not under an ICHRA model.
Mr. Silver said the decision to pilot the change for Indiana employees stemmed from several factors. While the state’s unique tax credit for ICHRA contributions is designed for small businesses, it’s created a positive regulatory environment for the coverage model.
“There’s competition, and more carriers than just us operate in Indiana,” Mr. Silver said. “As for the 700 people we have there, if we’re going to do a pilot to gather feedback, that’s a good size. It’s more manageable compared to some of our other markets with thousands of employees.”
The initial employee reaction at Centene has been more positive than anticipated, particularly among younger workers. Mr. Silver said his team is collecting feedback from multiple perspectives, including members, administrators, HR, and leadership.
“When we first announced it earlier in the year, change was difficult,” he said. “This is a big shift from a group health plan, so people had a lot of questions about networks, formularies, and ICHRA funding. A lot of people who were concerned about lower coverage levels were relieved once they realized they could access higher-level plans.”
ICHRA enrollment nationally has grown significantly over the last five years, with the overall market broadly estimated to contain between 500,000 to 1 million covered lives in 2025.
