Centene Adds $0 Marathon Primary Care to Some ICHRA Plans for 2027

An employer’s ICHRA gives workers tax-free money to buy their own health plan. Centene says some of those plans will now come with $0 primary care.

Starting in 2027, eligible members of Centene’s Ambetter Health Solutions plans in select counties of Indiana and Missouri will get $0 primary care visits and lab services, along with virtual primary care, through Marathon Health. Centene announced the deal on Oct. 7 in a press release. The benefit is sold through CHOICE Arrangements, which the release labels “formerly ICHRA.”

Marketplace open enrollment for 2027 coverage opened today, according to HealthCare.gov. Ambetter Health Solutions sells off the Exchange, so its members won’t find it there.

What Centene is selling

Ambetter Health Solutions is Centene’s off-Exchange individual business. Per the release, it sells individual plans built to work with ICHRAs in select states, including 13 it names, from Arizona to South Carolina. The Marathon benefit covers two of them, Indiana and Missouri, and only “select counties” there. The release doesn’t name the counties.

It also doesn’t say which metal levels carry the benefit, what the plans cost, or whether the $0 visits changed the premium. Members, it says, “will receive information about available services and how to access care prior to the beginning of the 2027 plan year.”

Alan Silver, president of Ambetter Health Solutions, pitched it to employers. “By combining the flexibility of CHOICE Arrangements with Marathon Health’s advanced primary care model, we’re making it easier for employers to offer meaningful healthcare access,” he said in the release.

CHOICE is the new name, not a new benefit. CMS’s employer guide says a CHOICE Arrangement is a health reimbursement arrangement that gives employees tax-free money to buy their own individual coverage, and that these arrangements “were previously known as Individual Coverage Health Reimbursement Arrangements (ICHRAs).”

Who Marathon is

Marathon Health runs onsite, nearsite and network clinics for employers and unions. It merged with Everside Health, a company DPC readers will know, in a deal announced in February 2024. By its own count, the combined company has more than 750 health centers in 41 states and more than 3 million covered lives.

Marathon describes its business in DPC’s vocabulary. The same page says “the company’s category of employer-sponsored direct primary care (DPC)” is growing fast.

The release adds an outcomes claim: Marathon says its model has produced 15% fewer emergency room visits and 41% fewer inpatient admissions among engaged members. The release gives no comparison group, time period or count of members. Read it as the company’s figure. The word “engaged” suggests it counts only members who used the service.

The premium question

The open question in this deal is where the primary care sits.

IRS Notice 2026-5 says an ICHRA can buy an individual bronze plan without costing that plan its standing as an HSA-qualified high-deductible plan. In the same answer, Q&A-5, it adds a condition: “generally, an HRA (including an ICHRA) is permitted to reimburse only premiums for the HRA to be a health plan that would not disqualify an employee from being an eligible individual.”

That condition matters to an employer pairing an ICHRA with an HSA. Our Oct. 27 piece walked through it.

Centene’s release leaves the premium question open. It doesn’t say whether the Marathon visits are part of the policy and its premium, or a separate program for eligible members.

Would $0 visits before the deductible break a bronze plan’s HSA status? For bronze, the notice says no. A footnote states that bronze plans “are treated as HDHPs under section 223 regardless of which services they cover before the deductible.” Whether Centene offers the Marathon benefit on bronze plans is one of the things the release leaves out.

A DPC membership works differently. The notice says a direct primary care arrangement stays outside the health plan rules when its fees are at or under $150 a month for one person, or $300 for an arrangement covering more than one. The worker can pay that fee from an HSA. But it’s a second purchase on top of the premium.

The counterargument

The strong claim here is that an insurer-bundled $0 visit beats an independent DPC membership in the small-employer market. On price at the point of care, for a worker already holding ICHRA dollars, it’s hard to argue with zero.

The other side has real weight, though. A DPC fee buys a standing relationship with a practice the patient chose, and no insurer’s network sits between them. The Marathon benefit is a feature of one carrier’s plan in some counties, for a plan year that hasn’t started. A DPC membership doesn’t depend on which policy the worker buys.

So the claim survives only in part. For an employer comparing line items, a $0 visit that comes with a plan it already pays for will look cheaper than a separate fee, and you might lose that comparison on a spreadsheet. If you run a DPC practice and sell to small employers in Indiana or Missouri, the case you make in 2027 is continuity: a doctor who stays when the plan changes.