Eugene Sayan is Softheon's Founder, Chairman, and CEO. He has 30 years of experience in health IT.
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Employer-sponsored health insurance is undergoing the same structural shift retirement plans did—from employer-dictated to employee-chosen. This change gives people the ability to get coverage that aligns with their individual needs instead of limited options of one-size-fits-all plans.
With group insurance premiums rising sharply in 2026, businesses are scrambling to offer quality and affordable healthcare coverage to their employees, and enrollees are more closely scrutinizing the value they receive from their coverage.
This environment is accelerating the transition to individual coverage Health Reimbursement Arrangements (ICHRA). Under this model, employers give tax-free reimbursements to employees, who then choose their own coverage from the individual marketplace. Businesses gain cost control, while employees have the freedom to shop for a plan that works for them.
However, health insurance decisions lack the support infrastructure that other e-commerce industries have. True coverage freedom means that people must understand what they’re choosing. Agentic artificial intelligence (AI) can fill this gap by empowering consumers to navigate the complex world of health insurance without adding operational burdens to administrators and health plans.
A few decades ago, employers defined the financial structure of the pension benefit, managed the investment and assumed the risk. If an employee changed jobs, they couldn’t take the money with them. This arrangement reduced job mobility, especially for younger employees, and left little room for optional, self-directed, tax-advantaged savings.
401(k)s changed the game by allowing employees to choose contribution amounts and investment portfolios and take their accounts with them to new jobs. As a result, companies reduce long-term liabilities, and employees control what they pay in and their risk exposure. A younger employee can invest in high-risk portfolios, while someone nearing retirement can move their money to low-volatility holdings.
Traditional employer-sponsored group insurance functions similarly to a pension plan. Employers dictate the insurance plan options, specify employee contributions and handle insurance administration and risk. This model creates cost uncertainty for businesses and locks employees into plans that may not fit their individual needs.
Like 401(k)s, ICHRA gives employees flexibility to choose what’s best for them. Employers define a monthly allowance that employees can use to purchase individual health insurance or cover eligible medical expenses. A young, single, healthy employee can enroll in a lower-cost plan with a higher deductible, while a person with chronic conditions and dependents can choose a higher premium with lower copays.
ICHRA is growing in popularity. Adoption increased by 34% among large employers in 2025. As more companies transition to ICHRA, more people will have to navigate plan selection and enrollment.
Many financial advisors and digital tools exist to help people with their retirement strategies, but the same is not true for health insurance. People must make these complex decisions on their own. According to a Softheon consumer survey, only 14% of respondents felt comfortable choosing their own health plan.
AI can make insurance enrollment as intuitive as investment decisions. AI agents act as a personal advisor, using a person’s health profile, preferred budget, location and other social determinants of health to make tailored plan recommendations.
With a large language model (LLM)-powered chatbot, members can ask questions in plain language and receive clear, personalized answers in real time. For example, someone with diabetes could compare the cost of a high deductible plan to one with lower copays or find out which plans have their doctor in-network.
Agents make health insurance choices more straightforward so people can confidently make this important decision.
Plan selection is only step one. Enrollment and effectuation are also complex processes. A typical enrollment requires the employee to shop for plans on an ICHRA administrator’s portal, a BenTech platform or directly from the health plan’s site. From there, enrollment data must flow to the health plan and the employer, and payment processing depends entirely on the employer's setup.
Each step introduces its own terminology, timelines and potential points of failure. Eligibility requirements vary by program and state, data often has to be entered more than once, and communication from plans, marketplaces and brokers is not always aligned.
Because employers manage less of this process, HR teams may have difficulties answering specific employee questions about the many different workflows.
AI unifies this fragmented enrollment journey. Agents can:
• Collect information
• Pre-populate forms
• Verify documents
• Check eligibility
• Calculate subsidies
• Route data to the correct systems behind the scenes
• Detect issues
• Generate targeted reminders
LLMs come into play again, allowing people to ask questions about items like required documentation, eligibility and approval timelines.
On the back end, AI standardizes data exchange, reduces manual review and ensures timely, consistent communications across employers, brokers, health plans, ICHRA administrators and marketplaces. The employee experiences less friction and fewer delays.
Even a small error in the enrollment process causes real harm. A delayed enrollment is a disruption to someone’s access to healthcare. Every step must be traceable and reproducible to meet federal and state regulatory obligations.
The required level of precision and safety cannot be achieved with a single, general-purpose model. Agentic AI is necessary because it distributes the work across specialized, auditable agents that execute tightly defined tasks and coordinate through durable workflows. These guardrails make it possible to safely automate the enrollment journey.
The success of individualized coverage like ICHRA goes beyond simple plan recommendations. People need clarity about both their health needs and the benefits each plan truly offers. Agentic AI holds the key to fulfilling the promise of ICHRA and helping every individual confidently manage their healthcare.
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