AI, APIs, and ICHRA: The Infrastructure Powering Personalized Health Insurance

If you have ever traveled overseas, you know the feeling: you plug in your hair dryer, the outlet does not match, and sparks fly. Worst case? The hair dryer dies.

In health insurance, sparks do not just fry a device. They can leave families without coverage. That is what the infrastructure of ICHRA looked like in its early years.

We learned that the hard way. In 2022, we implemented our first ICHRA for ourselves. Our co-founder, Timothy Edgar chose a Regence BlueShield plan. The catch? Regence refused to recognize ICHRA as a valid Special Enrollment Period, even though it had been the law for more than two years. It took 12 weeks for him to get coverage. The “fix”? Health Plan Finder Washington State told us to enroll Tim in Medicaid, get rejected, and use that denial to trigger enrollment.

Those were the growing pains of a new system. Three years later, carriers and administrators have come a long way. This week’s ICHRA Insider highlights the paradigm shift already underway and what's still needed to power ICHRA at scale.

The ICHRA Paradigm Shift: B2B to D2C

Group health insurance has had 80 years to evolve into the system we know today. It runs on predictable flat-file feeds, with HRIS and payroll systems built to support it, and tax reporting baked in. The customer experience is equally routine: one invoice per month, often integrated with payroll or an HRIS. For all its flaws, it operates with relatively little friction.

ICHRA is not just a new funding model. It flips the entire relationship.

In group health insurance, the employer is the policyholder. Carriers work with HR or accounting teams. The transaction is straightforward: one invoice, one check, managed by professionals on both sides.

With ICHRA, the employee becomes the policyholder. Carriers must suddenly operate like retailers: thousands of invoices, thousands of payments, and thousands of service calls coming directly from members.

In short, ICHRA transforms health insurance into a retail business. It is not only a change in who pays the bill, but it is a fundamental change in how the entire industry does business.

The Role of the ICHRA Administrator

As ICHRA pushes carriers from a B2B model into a D2C world, the role of ICHRA administrators becomes critical.

The best administrators soften the blow of this transition. They act as an extension of the carrier’s customer success team, supporting education, guiding members, and ensuring that coverage feels seamless rather than fragile.

ICHRA administrators can also provide an analytics layer that informs future plan design and customer acquisition strategies. For example, one carrier we partnered with measured how quickly members received their ID cards. That single metric revealed friction in their onboarding process and gave them actionable insights to improve the customer experience.

We see our role at Venteur as exactly that: easing this transition. In Spring 2025, we launched a Payer Operations Team led by industry veteran David Koelln . Dave previously served at UnitedHealthcare and supported its re-entry into the individual market. He has also served as a VP of Product in the ICHRA space. In under six months, Dave and the team have spoken with more than 60 carriers, and we are integrating with over half of them for Open Enrollment 2026 and beyond.

What we have learned so far:

1. It is about the people. You can have the most manual process in the world and still succeed if there is openness to solving for the member experience.
2. Integrations are expensive for both sides. The lightest-weight approach is often a secure file transfer and a CSV exchange. That may sound small, but when data systems are not aligned, fixing errors can take weeks.
3. Partnership must be two-way. Carriers often tell us they only hear from administrators after something has already gone wrong. Much of it is preventable. Better communication between carriers and ICHRA administrators can change that, and our goal is simple: help you succeed and make you look good

The Case for ICHRA Open Standards

We applaud the ICHRA Connect Portal published by Oscar Health last year. It was the most robust documentation we have seen from any carrier. Built from the perspective of an ACA carrier with a modern tech stack, it followed federal guidelines while adapting them to ICHRA use cases. Other carriers have published APIs as well, though many are still designed around group plan specifications rather than individual market standards.

Here are the things we liked about it:

• Built from the perspective of a carrier that exclusively serves the ACA. No irrelevant details, no unnecessary asks from the group space, only what is truly needed for individual market operations.
• Built on the EDE framework. The same infrastructure that powers Healthcare.gov has already been implemented by most of the industry.
• Designed with flexibility. The portal integrates both “low-hanging fruit” and more intensive approaches, allowing ICHRA administrators to scale up or down depending on need and ability to invest.

That said, openness to adopting "ICHRA Open Standards" remains mixed. Some carriers proudly call themselves “fast followers,” looking to adapt ICHRA Connect standards in their own way. Others have openly dismissed the idea that open standards are even possible.

In that vacuum, middleware actors like ICHRA: Powered by HealthSherpa and Ideon have stepped in. Middleware has played a role in bridging the market to where it is today. In the medium term, it can continue to help, but only if it follows open standards. When it does, it helps carriers and administrators modernize. When it does not, it risks turning ICHRA infrastructure into a maze of toll booths, making the system more expensive instead of more efficient.

Can AI Bridge the Lack of APIs?

In the absence of APIs and modern infrastructure, can AI bridge the gap? We asked ourselves this and built AI agents, systems where AI completes tasks, adapts to obstacles, and coordinates across systems.

Venteur's AI agent, Rosie, learns the quirks of each carrier and keeps coverage intact even when the pipes do not yet exist. She assists with enrollments and payments while creating a reliable audit trail for both. Rosie is not middleware; she is an adaptive AI layer that closes today’s gaps while we build tomorrow’s infrastructure.

But as we have scaled, we have learned a clear lesson: Rosie is a bridge, not the destination. AI can patch the system today, but only APIs can power it tomorrow. APIs are the standardized plug that provides security, balances workloads at scale, and prevents false fraud flags.

This creates a clear imperative: significant investment is still needed for ICHRA to work at scale, and much of that burden sits on the supply side of health insurance. Incumbent systems must be rebuilt to operate in a D2C world rather than a B2B one.

The Upside

ICHRA has moved from experiment to infrastructure. The shift from B2B to D2C creates friction, but it also forces modernization, and the upside is significant.

Consumers gain a system designed around their choices rather than their employer’s. Carriers gain the chance to build direct relationships with members, enable new ways of paying for coverage, and step into the role of a trusted partner instead of a perennial villain. Employers gain flexibility and cost control without losing the ability to provide meaningful benefits.

We often hear carriers say, “I am afraid of disrupting my current book of business.” But when nearly 72 million working-age Americans, or 41 percent, report problems with medical debt, is that really a reason to preserve the status quo? The opportunity is not in protecting yesterday’s book, but in building a consumer-centric infrastructure that rewards carriers for delivering real value, empowers employers to offer choice, and finally gives consumers a market that works for them.

For carriers, this is not just survival. It is a chance to lead. To be consumer-centric. To build new payment models. And to stop being seen as the villain in health care. That is the upside of ICHRA.