Centene Corporation is enrolling its own employees in the individual coverage health reimbursement arrangement (ICHRA) model it markets to other employers, and it’s now scaling that experiment beyond the single-state pilot it launched this year.
The St. Louis-based managed care company announced that its Ambetter Health Solutions arm will extend its CHOICE Arrangements program, the federal government’s official rebrand for ICHRAs, to all Ohio- and Oklahoma-based employees for plan year 2027. The rollout follows a 2026 pilot covering more than 700 of Centene’s Indiana-based workers, which the company described as successful enough to justify the expansion.
Centene is both a seller and now a scaled-up user of the ICHRA model. Its ICHRA commercial membership hit approximately 50,000 as of the second quarter of 2026, roughly two-and-a-half times its size a year earlier, according to the company’s Q2 2026 earnings call. CEO Sarah M. London has called ICHRA the “future of individual health insurance.” That context makes the internal rollout as much a market signal as a benefits decision.
“Our experience in Indiana has demonstrated the value of empowering employees with greater flexibility and choice in their healthcare decisions,” London said. “Expanding CHOICE Arrangements to our Ohio and Oklahoma employees reflects our confidence in this model.”
The Indiana pilot’s initial employee reaction was more positive than anticipated, particularly among younger workers, according to Alan Silver, president of Ambetter Health Solutions. Silver said the choice of Indiana for the first rollout was partly driven by the state’s favorable regulatory environment.
Indiana enacted the first state-level ICHRA tax credit in 2024, offering small employers up to $400 per employee in year one to adopt the model over traditional group coverage. Ohio has its own ICHRA tax credit bill advancing with bipartisan support. Ambetter also plans to add four more markets - Alabama, Iowa, North Carolina, and Pennsylvania - to its commercial ICHRA footprint in 2027.
Centene’s internal expansion sits inside a broader shift that is changing the nature of ICHRA conversations. According to the HRA Council’s 2025-2026 annual report, more than 20,000 US businesses now offer an ICHRA, a 53% jump from 2025, with covered lives surpassing 500,000. Applicable large employers, or those with 50 or more full-time equivalent employees, are now the fastest-growing segment, with adoption more than doubling year-over-year.
That large-employer momentum is where the model creates direct pressure for benefits advisors. An ALE rethinking its benefits structure is a different kind of client conversation than a small business exploring ICHRA as its first benefits offering, and it requires a different level of fluency. Yet the TASC 2026 Broker ICHRA Survey found that 54% of benefits brokers have still never sold an ICHRA, up from 47% in 2025. The share of brokers who fully support the product fell from 48% to 29% in the same period.
The 2026 EBRI-Morgan Health Employer ICHRA Survey, which gathered responses from nearly 1,000 benefits decision-makers, found that 77% of employers said a broker or benefits consultant recommendation would make them more likely to adopt an ICHRA. Among small employers not currently offering any health coverage, 55% were unaware that ICHRA was even an option.
Broker hesitation isn’t simply a knowledge gap. Paul Fronstin, director of health benefits research at the Employee Benefit Research Institute (EBRI) in Washington, D.C., has noted that ICHRA shifts meaningful risk onto employees. That risk is more immediate and potentially more consequential than most other defined-contribution benefit structures.
Under the model, employees choose their own plans from the individual market, and if they choose poorly or the market shifts, the employer’s fixed contribution may not cover adequate coverage. Fronstin noted that risk-transfer dimension belongs at the center of every broker conversation about the product, not as a reason to avoid it, but as the substance of the advice.
Centene’s move doesn’t settle the question of whether the model works at scale for a general employer base. A carrier rolling out the product to its own workers, while also selling it commercially, is not an independent proof of concept. But the pattern it sits inside is concrete: accelerating large-employer adoption, a growing state incentive landscape, and 77% of employers saying a broker recommendation is what it would take to move them from interest to action.
