What we learned about the future of ICHRA at AIM 2026

At AIM 2026: Aligning ICHRA Minds, the conversations happening in Indianapolis weren't focused on whether the individual coverage health reimbursement arrangement (ICHRA) works. Instead, they centered on how to scale it, optimize it, and make it even easier for employers and employees to adopt.

From market data and policy developments to employer case studies and carrier insights, attendees gained a clearer picture of where ICHRA is headed and what opportunities lie ahead.

Here's a look at some of the biggest takeaways from AIM 2026.

The affordability crisis for small employers is creating momentum for ICHRA

One of the most discussed topics throughout the conference was the ongoing strain that rising healthcare costs place on employers, particularly small businesses.

Data from the NFIB's Addressing the Health Insurance Affordability Crisis for Small Businesses report¹ was shared during the "Behind the Headlines" session. It showed that premiums for small employers have increased more than 120% over the past two decades, while only 30% of small businesses offer health benefits today. That’s down from 50% in 2000. The session also noted that smaller organizations often spend a significantly larger share of payroll on health benefits than larger firms, underscoring the need for more sustainable benefit strategies.

As affordability challenges continue to grow, small businesses are increasingly looking for alternatives that provide predictable costs without sacrificing quality coverage. For many organizations, ICHRA is becoming that solution.

We’ve seen this first-hand at Remodel Health. As Jon Whitmer, Senior Vice President of Carrier Relations, shared before the conference’s opening keynote, January through April 2026 revenue from new qualified small employer HRA (QSEHRA) and ICHRA customers with our new-to-coverage PeopleKeep product increased 69% year-over-year.

Many of these new customers had previously been sending their employees to the individual Marketplace to take advantage of subsidies. But with the recent expiration of enhanced advance premium tax credits, many were looking for a new cost-effective solution.

Employers are moving beyond adoption and focusing on optimization

Several breakout sessions focused on how employers can design smarter ICHRAs that balance cost control, employee engagement, and long-term sustainability.

While many employers begin with benchmark-plan contribution strategies that mimic traditional group health insurance, attendees discussed a growing trend toward defined contribution models that provide greater flexibility and budget predictability.

Additional topics included:

• Age-banded ICHRA contribution strategies
• Employee classes and carve-outs
• Qualified medical expense (QME) HRAs
• Affordability-based contribution models

The evolution of these conversations reflects the maturity of today's market. Employers are no longer asking whether they should offer an ICHRA. They're asking how to design the most effective one.

State tax credits continue to gain momentum

Multiple states have either adopted or introduced ICHRA-related legislation, including tax credit programs that help offset employer costs. Just days after AIM, Connecticut became the third state to pass an ICHRA tax credit for eligible small employers.

A recurring theme throughout the conference was that many employers and brokers remain unaware of these incentives. Some attendees specifically requested additional educational resources on state tax credits and legislative developments.

As more states explore ways to support ICHRA adoption, these incentives could become an increasingly important driver of market growth.

The future of ICHRA is increasingly off-exchange

Several AIM sessions explored how the individual market is evolving to support continued ICHRA growth. One of the most data-rich discussions came from the "ICHRA Market Insights: What the Data is Telling Us" session presented by Michael Levin, Senior Vice President of ICHRA at Health Sherpa.

According to HealthSherpa, the largest ACA private exchange in the U.S., approximately 82% of ICHRA enrollments now occur off-exchange. HealthSherpa, which supports more than 100,000 ICHRA members, also reported that carriers increased off-exchange plan offerings by 36% from 2025 to 2026. The trend reflects growing carrier investment in ICHRA and the continued expansion of ICHRA-focused health plans.

Additional insights from Levin included:

• Off-exchange ICHRA plans are often less expensive than comparable exchange plans across all metal levels.
• More carriers are introducing products specifically designed for ICHRA populations.
• ICHRA is helping drive growth in the off-exchange market.
• While network options remain heavily EPO and HMO-based, carriers continue expanding plan choices for ICHRA participants.
• The market has now grown to approximately 1 million ICHRA members nationwide.

These findings were reinforced in sessions such as "The ICHRA Era: ICHRA is Winning, Are You?" and "Building Rails," where industry leaders discussed increasing carrier participation, the rise of ICHRA-specific health plans, and the infrastructure needed to support continued adoption.

The takeaway was clear: carriers are making long-term investments in ICHRA. As off-exchange enrollment continues to grow and more plans are built specifically for ICHRA participants, employers and employees will have access to an increasingly robust and competitive marketplace.

Infrastructure is becoming the next frontier

As ICHRA adoption continues to accelerate, industry leaders emphasized the importance of improving the infrastructure supporting the market.

Panel discussions focused on opportunities to streamline:

• Payroll integrations
• Reimbursements and deductions
• Eligibility management
• COBRA administration
• Ancillary benefits enrollment

While enrollment and eligibility processes have improved significantly over the past several years, attendees agreed that creating a more seamless experience for employers and employees will be critical to the next phase of growth.

At Remodel Health, we're helping employers navigate this next phase of ICHRA adoption.

We continue to invest in the technology, integrations, and support needed to simplify administration and improve the employee experience, including:

• 200+ payroll and HRIS integrations that reduce manual work and keep benefits data synchronized across systems.
• Automated premium payments through AutoPay to help employers streamline administration and reduce reimbursement complexity.
• Ongoing platform enhancements that simplify enrollment, eligibility management, and benefits administration.
• Dedicated support teams that help employers, brokers, and employees navigate the ICHRA experience with confidence.

As the market continues to grow, infrastructure will play an increasingly important role. Administrators that can reduce friction, improve connectivity, and create a seamless experience for employers and employees will help shape the future of ICHRA.

What this means for the future of ICHRA

The biggest takeaway from AIM 2026 is that ICHRA is no longer an emerging concept.

The market has surpassed an estimated one million covered members. Carriers are expanding their investments. Policymakers are introducing legislation to support adoption. Employers are implementing increasingly sophisticated plan designs.

Most importantly, the industry is shifting from conversations about awareness to conversations about scale.

At Remodel Health, we’re leading this momentum. As the nation's largest ICHRA administrator, we continue to invest in the technology, expertise, and partnerships needed to help brokers and employers navigate this rapidly evolving market.

The future of health benefits is becoming more personalized, more flexible, and more affordable. AIM 2026 demonstrated that ICHRA is helping lead that transformation.

Want to stay connected? Follow Remodel Health on LinkedIn and visit our website for updates on AIM 2027, including registration details, speaker announcements, and event news. In the meantime, revisit the biggest moments from this year's conference by watching our AIM 2026 recap video.

References

1. NFIB Report: Addressing the Health Insurance Affordability Crisis for Small Businesses