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How CHOICE arrangements bring budget predictability to your organization | hioscar Blog | Oscar
How CHOICE arrangements bring budget predictability to your organization
Learn how CHOICE is transforming employee benefits by offering employers budget predictability and employees personalized healthcare choice.
How Insurance WorksOscar Insights
5 min read
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For decades, the standard choice for most American businesses has been the traditional group health insurance plan. While this model has long served as the default, it is no longer the only path forward for employers who need more adaptability.
Small and medium-sized companies often face unique challenges with traditional group plans, including unpredictable annual renewals and limited coverage options that don’t always fit a diverse team. These constraints can make it difficult for growing businesses to manage costs while still providing meaningful support to their employees.
CHOICE Arrangements (formerly ICHRA) (opens in new tab) offer a different approach by shifting the focus toward flexibility and predictability. Instead of selecting a single plan for the entire company, employers set a monthly budget that works for their bottom line. Employees then use those tax-free funds to select an individual marketplace plan that best fits their personal health needs and preferred doctors.
“We are committed to giving more individual choice to Americans,” DeStefano said. “While the employer healthcare model remains, many employers – and small and medium-sized businesses in particular – are offering the benefits that they think are best for people but they are actually making decisions on their behalf and limiting their choices and freedom.”
How CHOICE works
1. Employers set a predictable budget
Businesses decide on a fixed, monthly, tax-free contribution to put toward employees’ healthcare. This locks in the costs for the year, simplifies budgeting, and provides tax benefits for the business.
2. Employees shop for a flexible plan
Employees get to shop the individual healthcare marketplace, which offers hundreds of ACA-compliant plan options from top carriers, including Oscar. They can compare and choose a plan designed specifically for their personal health needs and preferences.
3. Employees gain freedom of choice.
Each employee selects the plan that includes their preferred doctors and fits their personal budget. Because they aren’t locked into a single company plan, they have the flexibility to switch or update their coverage every year as their life changes.
These mounting costs often force companies to make tough choices: either shift more of the cost burden to employees, or cut back on coverage. While employer-sponsored coverage continues to see rising premiums and fragmented experiences, the individual market has quietly achieved something unexpected to many: cost control. The ACA market has grown to almost 22 million lives (opens in new tab), creating a larger, more stable risk pool than any single employer could manage, resulting in a lower cost trend than the rest of the industry.
This stability is by design, rooted in the individual market’s risk-adjustment system (opens in new tab). This mechanism balances financial performance across insurers; those that outperform the broader market contribute to a shared pool, while those that fall short receive support. This redistribution helps stabilize pricing – especially for people with chronic conditions – and discourages plans from cherry-picking members.
Employers benefit by shifting the burden of managing risk of smaller risk pools to a marketplace of over a million lives. This structural advantage can lead to significant savings; some companies have cut their healthcare costs by 15.5% on average after switching from employer plans to the individual market (opens in new tab). The result is a solution that addresses the tough reality small employers face today: double-digit rate increases, broad networks with high price tags, and limited ways to personalize coverage for their diverse workforces.
CHOICE leverages a defined contribution model that is a familiar concept similar to a 401K, which fundamentally shifts how benefits are managed.
For Employers: CHOICE provides budget predictability by turning a variable liability into a fixed asset. It reduces administrative burden, as the employer simply sets a monthly budget and is no longer responsible for vetting plans, managing dozens of point solutions, or underwriting the long-term impact of high-cost prescriptions – that risk is carried by the individual insurer. Furthermore, it offers total eligibility control, allowing small businesses to customize contributions by group (e.g., full-time, part-time, seasonal, or geographic location).
For Employees: Employees gain more control, plan portability, and better alignment with their specific health needs. They get to choose from dozens of plans in the marketplace, rather than one or two selected by their employer, ensuring they select the plan that works best for their family and lifestyle.
CHOICE: The future of healthcare
Ultimately, the employer-sponsored insurance model was built for a different era, and it is failing to keep pace with the needs of modern workers and businesses. CHOICE represents the structural solution to this broken system by giving consumers more choice and leveraging the stability of the individual market. By shifting to a defined contribution model, Oscar believes that putting financial power back into the hands of Americans will drive the competition and creative plan design necessary to make healthcare truly affordable and innovative.
While the individual market model (CHOICE) is effective, its widespread growth and stability depend on continued legal and political support. Oscar is actively advancing the legislative evolution of CHOICE through a dual-pronged policy approach:
State momentum: The company is supporting the passage of existing bills and cultivating new legislative initiatives to increase CHOICE adoption in multiple states.
“We need to continue innovating around CHOICE legislation,” DeStefano said. “Putting financial control directly into the consumer’s hands drives competition and results in more innovative products. This shifts the decision-making power, allowing employees to choose what’s best for their families, health, and lifestyle, while the funding is still provided by the employer.”
Oscar Medical coverage is underwritten by Oscar Insurance Company and its affiliates. Administrative Services for all plans provided by Oscar Management Corporation. All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs, and complete details of coverage, contact Oscar at 855-672-2788.
