The Rise of Alternative Health Coverage Models: Short-Term Duration Plans, Health Care Sharing Ministries, and ICHRAs
Over the past decade, the U.S. health insurance landscape has experienced a surge in alternative coverage models that operate outside of traditional ACA-compliant insurance. Short-Term Duration Health Plans (STPs), Health Care Sharing Ministries (HCSMs), and Individual Coverage Health Reimbursement Arrangements (ICHRAs) have all grown in prominence, offering new pathways to coverage for consumers and employers alike. While each model serves different needs, they share the common feature of being exempt, wholly or partially from ACA standards.
With the Trump administration back in office, the policy and regulatory environment surrounding these models has already shifted. Early executive actions and agency guidance suggest a renewed emphasis on deregulation and consumer-directed health models. These developments coincide with the scheduled expiration of enhanced ACA subsidies and potential reductions in federal Medicaid and Medicare funding - factors likely to accelerate the migration of individuals and employers toward these alternative options.
This paper explores the regulatory foundations, market trends, and implications for consumers and insurers, and outlines why understanding their structure, use cases, and policy exposure is essential for market participants and policymakers alike.
