As the benefits landscape evolves, employers and brokers are exploring new models that promise greater flexibility, personalization, and cost control. During our recent webinar, “The Hottest Acronyms of 2026: ICHRA, DPC, and AI,” our experts from Ameriflex, Accresa, and Workforce Go unpacked how these trends are shaping the future of healthcare benefits. Below are the most common questions we received from attendees and the answers that followed.
Q: How long has ICHRA been an option?
A: Individual Coverage Health Reimbursement Arrangements(ICHRAs) were created by an executive order during the first Trump administration in 2018 and became available to employers in 2020. They began gaining real traction in 2019 and have continued to grow since. Although full codification into law was dropped from later legislation, ICHRAs are now so widely adopted that they’re not going anywhere.
Q: Are ICHRAs most effective in rural and underserved markets?
A: They certainly can be, but their benefits extend far beyond those areas. While smaller or underserved employers often find ICHRAs appealing due to cost and flexibility, we’re seeing strong adoption across all types of markets, including government and multi-state employers.
One major advantage of ICHRAs is geographic flexibility. For instance, if your workforce spans multiple states, ICHRAs let each employee select coverage that fits their local network. That’s something traditional group plans can’t easily offer.
Q: For groups under 20, can ICHRAs be used to pay for Medicare Supplement and drug plans?
A: Yes. ICHRAs can reimburse Medicare Supplement and Part D premiums. The key compliance rule is that employers cannot incentivize employees to leave the group plan and move to Medicare, but you can offer it as an option within your ICHRA structure.
Q: How robust is the provider network in the ICHRA market?
A: It varies by state, since individual market strength differs regionally. But overall, the provider access under an ICHRA is not weaker than traditional group coverage. In fact, as interest in ICHRAs grows, we’re seeing more carriers develop competitive individual plan options to serve this market.
Q: What about Direct Primary Care (DPC)? Is it just for preventive care?
A: DPC goes far beyond preventive care. It covers routine and sick visits, from flu symptoms to stitches and often includes in-house services like imaging, lab work, prescriptions, or even mental health and nutritional support. It’s designed to provide easier, more personal access to care when you need it most, without worrying about copays or network restrictions.
Q: Does Direct Primary Care cover preexisting conditions?
A: Absolutely. DPC memberships don’t exclude preexisting conditions. While specific services like physical therapy depend on the practice’s membership tier, patients with chronic conditions often benefit most from the continuous, accessible care DPC provides.
Q: How robust is the provider network for DPC?
A: DPC providers are now found in every state, with growing coverage in both urban and rural areas. While some states have a denser presence than others, DPC works best locally, giving employees reliable access to nearby physicians who can provide in-person and virtual care.
Q: When using DPC, do you have consistency with providers? Are visits in-person?
A: Most DPC visits are in-person, though virtual visits are often available. Because DPC practices are independent, consistency across multiple states can vary. However, Accresa helps employers build partnerships with practices that offer unified membership structures to ensure consistent care for all employees, regardless of location.
Q: What are the biggest risks or concerns when moving from traditional health plans to ICHRAs?
A: Employers often worry about setup complexity and how employees will perceive the shift. Ameriflex addresses these concerns head-on. We provide hands-on guidance for setup and communication, helping HR teams present ICHRAs effectively to employees. Our TAAP (The Ameriflex Alternative Plan) model enhances ICHRAs with concierge care navigation, direct-to-carrier payment, and robust administrative support, ensuring employees see ICHRAs as an upgrade, not a downgrade.
Q: Can employers offer different contribution amounts to different employees under an ICHRA?
A: Yes. Employers can vary contributions based on one of 11 IRS-approved classes, such as full-time vs. part-time, salaried vs. hourly, or geographic region. You can even apply age-based contributions or rating areas for added flexibility.
Q: I’m hearing ICHRAs aren’t very popular in Arizona. Why is that?
A: In some areas, small group health plans are still priced very competitively, which can slow ICHRA adoption. However, as premiums inevitably rise, interest will increase. It’s also worth noting that some brokers are hesitant to adopt ICHRAs because they traditionally earn commissions from group plans. Ameriflex’s model eliminates that barrier by allowing brokers to retain the Broker of Record (BOR) at no extra cost, ensuring fair compensation while bringing modern benefits solutions to clients.
Q: Can you elaborate on the “variance risk” across different DPC providers?
A: Because DPC practices are independent, their membership tiers and included services can vary. Some may include labs or therapy; others may not. Employers should ensure their provider network offers a consistent level of care across all locations. Accresa works directly with employer groups to create that consistency, aligning providers under a unified offering so employees receive the same quality of care no matter where they live.
To Sum It Up
Both ICHRAs and Direct Primary Care are transforming how employers approach healthcare benefits. They offer flexibility, affordability, and a better employee experience, but they also require thoughtful design and the right partner to implement effectively.
For further information, visit our webinar page and explore our resources including contact information and the slide deck.