Can HRAs reimburse insurance premiums?

Yes, HRAs can reimburse insurance premiums—but only certain types of HRAs are designed to do so.

Whether premiums are eligible for reimbursement depends on the type of HRA being offered and the employer’s plan design.

🧾 HRAs That Can Reimburse Premiums:

✅ ICHRA (Individual Coverage HRA)

  • Designed specifically to reimburse employees for individual health insurance premiums (on or off the Marketplace)

  • Can also reimburse Medicare premiums and other out-of-pocket medical expenses

  • Employees must be enrolled in qualifying individual coverage to participate

✅ QSEHRA (Qualified Small Employer HRA)

  • Available to small employers (fewer than 50 full-time employees)

  • Can reimburse individual health insurance premiums and other eligible medical expenses

  • Monthly reimbursement limits apply and are adjusted annually

✅ Retiree HRA

  • Typically used to reimburse Medicare premiums and other eligible retiree healthcare expenses

  • Retiree-only HRAs have more flexibility since they are exempt from many ACA requirements

🚫 HRAs That Usually Can’t Reimburse Premiums:

â›” Integrated HRAs (offered alongside a group health plan)

  • Typically reimburse out-of-pocket expenses only—not premiums

  • Must be integrated with a major medical group plan to comply with ACA rules

That said, some plan designs may allow limited premium reimbursement (e.g., COBRA premiums or retiree continuation), but it’s not the primary purpose of an integrated HRA.

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