Employer reviewing ICHRA contribution benchmark data at a bright office table

How do employers decide the right ICHRA contribution amount? ¿Cómo deciden los empleadores el monto correcto de contribución de ICHRA?

Q: What does an ICHRA contribution amount actually need to cover?

An ICHRA contribution needs to be large enough that the employee's remaining share of the Lowest Cost Silver Plan stays at or under 9.96% of income in 2026, the threshold set by IRS Rev. Proc. 2025-25.

Q: What reference data do employers use to benchmark a number?

Employers typically combine the CMS Lowest Cost Silver Plan premium by ZIP code, the prior year's per-employee group-plan spend, and published market averages such as the 2024 KFF Employer Health Benefits Survey.

Q: How do ICHRA employee classes change the contribution by group?

ICHRA regulations permit up to 11 employee classes, each eligible for a different contribution amount under 26 CFR §54.9802-4, as long as classes are defined by permitted criteria rather than health status.

Q: What happens if the contribution amount is set too low?

A below-threshold contribution does not void the offer; it lets the employee decline the ICHRA in writing and pursue Advance Premium Tax Credits on the Marketplace instead, and it can raise penalty exposure for applicable large employers under IRC Section 4980H.

Q: Which IRS safe harbor methods set the number?

Three IRS safe harbors exist: the W-2 wage safe harbor, the rate of pay safe harbor, and the federal poverty line safe harbor, each letting an employer prove affordability without knowing an employee's actual household income.

An ICHRA allowance is math, not guesswork. This explains the benchmarks, IRS safe harbors and comparison data employers use to land on a number for 2026.

Un monto de ICHRA es matemática, no una suposición. Aquí están los puntos de referencia, los safe harbors del IRS y los datos que los empleadores usan para fijar una cifra en 2026.

Key takeaways

What does an ICHRA contribution amount actually need to cover? ¿Qué debe cubrir realmente un monto de contribución de ICHRA?

An ICHRA (Individual Coverage Health Reimbursement Arrangement): a federal benefit framework under 26 CFR §54.9802-4 that lets employers reimburse employees tax-free for individual market premiums contribution does not need to cover 100% of any premium. It needs to be large enough that the employee's remaining share of the benchmark plan stays at or under 9.96% of income in 2026, the threshold set by IRS Rev. Proc. 2025-25, because that single ratio determines whether the offer counts as "affordable" for Marketplace subsidy and, for applicable large employers, Section 4980H purposes.

Una contribución de ICHRA no necesita cubrir el 100% de ninguna prima. Debe ser suficiente para que la parte restante que paga el empleado del plan de referencia se mantenga en o por debajo del 9.96% del ingreso en 2026, el umbral fijado por el Rev. Proc. 2025-25 del IRS, porque esa proporción determina si la oferta cuenta como "asequible".

How does the 9.96% affordability threshold limit the number? ¿Cómo limita el umbral de asequibilidad del 9.96% la cifra?

The 9.96% threshold caps the employee's required contribution toward the LCSP(Lowest Cost Silver Plan): the benchmark premium CMS publishes by rating area, used to test ICHRA affordability, not the employer's total spend. An employer works backward: find the LCSP premium in an employee's rating area, multiply the chosen income figure by 9.96%, and the ICHRA allowance must be at least the gap between those two numbers to pass. A lower allowance is legal, it simply means the plan may be deemed unaffordable, per 26 CFR §54.9802-4.

El umbral del 9.96% limita la contribución requerida del empleado hacia el LCSP, no el gasto total del empleador. Un empleador trabaja al revés: busca la prima del LCSP en el área de clasificación del empleado, multiplica la cifra de ingreso elegida por 9.96%, y el monto de ICHRA debe cubrir al menos esa brecha para aprobar la prueba, según 26 CFR §54.9802-4.

What reference data do employers use to benchmark a number? ¿Qué datos de referencia usan los empleadores para calcular una cifra?

Employers typically triangulate three data points: the CMS Lowest Cost Silver Plan premium by ZIP code, the prior year's per-employee group-plan spend, and published market averages. Group health premiums for small employers rose 8% to 12% annually heading into 2026 renewals, according to the 2024 KFF Employer Health Benefits Survey, which gives a floor for what "competitive" looks like. PeopleKeep's 2026 ICHRA Report and Take Command's affordability calculator both publish anonymized allowance ranges by class and region, useful as a sanity check rather than a target to copy exactly.

Los empleadores suelen triangular tres datos: la prima del LCSP de CMS por código postal, el gasto grupal por empleado del año anterior y los promedios del mercado publicados. Las primas de salud grupal para pequeños empleadores subieron entre 8% y 12% anualmente de cara a las renovaciones de 2026, según la Encuesta de Beneficios de Salud del Empleador 2024 de KFF.

How do ICHRA employee classes change the contribution by group? ¿Cómo cambian las clases de empleados de ICHRA la contribución por grupo?

ICHRA regulations permit up to 11 employee classes, full-time, part-time, salaried, hourly, seasonal, and by geographic rating area among them, and each class can receive a different contribution amount under 26 CFR §54.9802-4. A $500 monthly allowance for full-time staff and a $250 allowance for part-time staff in the same company is permitted as long as the classes are defined by the permitted criteria, not by a proxy for health status. Contractors paid on a 1099 are not employees and cannot form a class.

Las regulaciones de ICHRA permiten hasta 11 clases de empleados (tiempo completo, medio tiempo, asalariados, por hora, temporada y por área geográfica, entre otras), y cada clase puede recibir un monto distinto según 26 CFR §54.9802-4. Un monto mensual de $500 para personal de tiempo completo y $250 para medio tiempo es permitido siempre que las clases se definan por criterios permitidos.

What happens if the contribution amount is set too low? ¿Qué pasa si el monto de contribución se fija demasiado bajo?

A contribution below the 9.96% affordability line in 2026 does not void the ICHRA offer, it changes what the employee can do with it. Under IRS rules, an employee facing an "unaffordable" ICHRA can decline the offer in writing and pursue APTC(Advance Premium Tax Credit): a federal subsidy that lowers Marketplace premiums, unavailable to anyone whose employer ICHRA offer is deemed affordable on the Marketplace instead, per the IRS Premium Tax Credit guidance. For an applicable large employer, a too-low allowance also raises exposure under the employer shared responsibility provisions of Internal Revenue Code Section 4980H.

Una contribución por debajo de la línea de asequibilidad del 9.96% en 2026 no anula la oferta de ICHRA, cambia lo que el empleado puede hacer con ella. Bajo las reglas del IRS, un empleado frente a un ICHRA "inasequible" puede rechazar la oferta por escrito y buscar el crédito APTC en el Mercado.

How does an ICHRA contribution compare to a group-plan renewal cost? ¿Cómo se compara una contribución de ICHRA con el costo de renovación de un plan grupal?

Comparing the two starts with one number: current total employer spend per employee per month on the group plan, divided across the same classes being proposed for ICHRA. With group renewals running 8% to 12% a year (2024 KFF Employer Health Benefits Survey), an employer holding the ICHRA allowance flat or indexing it to a smaller percentage can convert an open-ended medical trend line into a fixed, predictable line item, a structural difference that is the main driver behind 2.8 times year-over-year ICHRA enrollment growth in 2025, per the HRA Council.

Comparar ambos empieza con un número: el gasto total actual del empleador por empleado al mes en el plan grupal, dividido entre las mismas clases propuestas para ICHRA. Con renovaciones grupales entre 8% y 12% al año, mantener el monto de ICHRA fijo convierte una tendencia médica abierta en una línea de costo predecible.

What tools calculate an ICHRA contribution amount automatically? ¿Qué herramientas calculan automáticamente un monto de contribución de ICHRA?

Several platforms publish free or lead-gated affordability calculators that run the LCSP-versus-wage math automatically. PeopleKeep's ICHRA affordability calculator and Take Command's ICHRA affordability calculator both accept a ZIP code and wage figure and return a minimum allowance by safe harbor. None of these tools substitute for a licensed agent confirming plan availability in a specific county, since the underlying LCSP data changes by rating area and by year.

Varias plataformas publican calculadoras de asequibilidad gratuitas o con registro que automatizan el cálculo de LCSP frente al salario. Las calculadoras de PeopleKeep y Take Command aceptan un código postal y una cifra salarial y devuelven un monto mínimo por safe harbor. Ninguna sustituye la confirmación de un agente con licencia.

Which IRS safe harbor methods set the number? ¿Qué métodos de safe harbor del IRS fijan la cifra?

Three IRS safe harbors let an employer prove affordability without ever learning an employee's actual household income, each pulling from data the employer already has on file.

Tres safe harbors del IRS permiten a un empleador comprobar la asequibilidad sin conocer el ingreso familiar real del empleado, cada uno usando datos que el empleador ya tiene.

Safe harbor	How the number is calculated	Where it's commonly used
W-2 wage safe harbor	Employee's share of the LCSP premium capped at 9.96% of Box 1 W-2 wages	Employers with stable, salaried W-2 populations
Rate of pay safe harbor	9.96% of monthly rate of pay (hourly rate x 130 hours, or monthly salary)	Employers with hourly or variable-wage workers
Federal poverty line (FPL) safe harbor	9.96% of the federal poverty line for a single individual, divided by 12	Employers wanting one fixed number regardless of wage data

The FPL(Federal Poverty Level): the income benchmark HHS publishes annually, used here as the simplest of the three ICHRA affordability safe harbors safe harbor uses the federal poverty level for a single individual, published by HHS and referenced on healthcare.gov's FPL glossary page, as the income figure regardless of actual wages.

El safe harbor de FPL usa la línea de pobreza federal para una persona, publicada por HHS, como la cifra de ingreso sin importar el salario real.

"A contribution amount only has to clear one of three IRS safe harbors to be defensible, not the employee's actual household income, which an employer never sees under 26 CFR §54.9802-4."

"Un monto de contribución solo necesita superar uno de los tres safe harbors del IRS para ser defendible, no el ingreso familiar real del empleado, que un empleador nunca conoce bajo 26 CFR §54.9802-4."

Run the numbers before setting an allowance

The ICHRA affordability tool applies the three safe harbors above to a specific ZIP code and wage figure and returns a minimum allowance range.

La herramienta de asequibilidad de ICHRA aplica los tres safe harbors anteriores a un código postal y salario específicos y devuelve un rango mínimo de contribución.

Open the ICHRA affordability tool

What steps do employers typically take to set a defensible number? ¿Qué pasos siguen los empleadores para fijar una cifra defendible?

Employers working through this question often explore a sequence rather than a single calculation, since a safe-harbor result changes by ZIP code and by wage class.

Los empleadores que resuelven esta pregunta suelen seguir una secuencia en lugar de un solo cálculo, ya que el resultado del safe harbor cambia según el código postal y la clase salarial.

Talk to a licensed agent about a specific contribution design

InsureICHRA designs and runs ICHRA programs for employers nationwide. Enrolling any individual employee in a plan is handled by a licensed agent in that employee's state.

InsureICHRA diseña y gestiona programas de ICHRA para empleadores en todo el país. La inscripción de cualquier empleado en un plan la gestiona un agente con licencia en el estado de ese empleado.

Read the IRS Notice 2026-05 explainer

Disclaimer : InsureICHRA designs and runs Individual Coverage HRAs for employers anywhere in the United States, and publishes the research behind that work. We are not a law firm, an accounting firm or an insurance carrier, and nothing here is legal or tax advice. Enrolling an employee in an individual health plan is handled by licensed agents in the states where they hold a license. Information may become outdated and may not apply to your situation.: InsureICHRA diseña y gestiona Individual Coverage HRAs para empleadores en todo Estados Unidos, y publica la investigación que hay detrás de ese trabajo. No somos un bufete, ni una firma contable, ni una aseguradora, y nada de esto es asesoría legal ni fiscal. La inscripción de un empleado en un plan individual la gestionan agentes con licencia en los estados donde la tienen. La información puede quedar desactualizada.

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