Healthcare Trends

How Level-Funded Plans Create Demand for ICHRAs 

Stacy Edgar
Sep 16, 2023

Recently, there's been a shift in the insurance scene. Small businesses are looking towards level-funded health plans as their savior from the traditional insurance mold. It's alluring, sure, but there's a ripple effect. These level-funded plans are shrinking the risk pool for small businesses, causing prices to rise. This, interestingly, increases the importance and demand for the Individual Coverage Health Reimbursement Arrangement (ICHRA). Let’s dive into the dynamics.

So, What's a Level-Funded Plan Anyway?

Imagine a plan that sits between self-insurance and fully insured models. That's a level-funded plan. Businesses pay a fixed rate every month, based on what they think their employees' health care costs will be. If they overshoot the estimation, they might even get a refund at the end of the year's end. Sounds great for companies with healthier teams, but it's shifting the balance in the broader insurance world.

How Traditional Small Business Insurance Works 

Traditionally, small businesses health plans are pooled together and “community rated.”. Think of it like a pot where everyone's risks and costs get mixed together. Underwriting is based on population demographics, instead of medical history or group utilization. Everyone shares the load, so if one business faces hefty health claims, the burden gets spread out. It's community-rated, meaning the price you pay is based on the health and risk of the whole community, not just your own business.

Here’s the Catch

Level-funded plans are pulling healthier businesses out of that communal pot. These are businesses with fewer health claims. They're hopping over to level-funded plans, leaving behind a community pool that's got more high-risk, high-claim businesses. This imbalance affects all the remaining businesses in two big ways:

1. Rising Premiums: With more high-risk businesses in the pool, insurance prices shoot up. Everyone has to pay more to cover the higher predicted health claims.  

2. Fewer Choices: Insurance companies don't want to lose money. If they're left with a high-risk pool, they might offer fewer plan options or leave the small business market altogether.

So Where Does ICHRA Fit Into This?

As level-funded plans pull businesses away from the traditional risk pool, it's causing a ripple effect in the ACA shared risk pool. It's here that ICHRAs are finding their strength. With ICHRAs, businesses tap into the larger, more stable ACA risk pool for individuals, which now has more participants than most small business pools in states. Remember, the bigger the risk pool, the better the stability. And when the risk pool has a good mix of individuals (healthy or not), insurance costs can be balanced, possibly even reduced.


Level-funded plans are certainly shaking things up. They might offer some businesses cost savings, but they're also narrowing the risk pool and pushing up prices. Meanwhile, the rise of ICHRAs and their interaction with the vast ACA risk pool is hinting at a potential solution – one that creates an environment of affordability for all. The future of insurance? It might just be about tapping into these vast, diverse risk pools and realizing that together, we find balance.

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