A new era for consumer choice: Oscar’s CEO lays out his vision for the individual insurance market

For most people, few choices are more personal than those involving their healthcare.

Yet in the United States, healthcare decisions are rarely personal. Instead, they’re shaped by HR departments, benefits managers, and chief financial officers – all because of the employer-sponsored insurance model.

Americans feel the impact of this system every day. It drives up healthcare costs, limits plan choices, and means that, when employees change jobs, they often lose their coverage.

During a live event with The Washington Post Oscar Health CEO Mark Bertolini made a strong case for a better alternative: the individual market. “The individual market offers employees and consumers the ability to choose their own product, choose their own network, choose their own coverage at a cost that's affordable and competitive,” he said in an interview with journalist Kathleen Koch.

Here are the most important takeaways from their conversation.

The individual market gives consumers more choice and control

For many Americans, choosing a healthcare plan typically means selecting from a short list of pre-approved options selected by their employers. This often results in higher costs and fewer options, regardless of employees’ specific needs.

The individual market flips that dynamic on its head because “employees can see what they're buying,” said Bertolini. “I can find my network, my doctor, my hospital, which when people change situations, employers, or are in and out of employment, they have to find another plan and another network.”

This is the kind of choice that consumers increasingly expect. Roughly 75% of people say they want more choice in healthcare, with experiences that mirror those of retail and banking.

The individual market is already a game-changer for gig workers, many of whom are locked out of traditional insurance models. The combination of defined contributions and flexible plan options could finally give many of them coverage that fits their individual health needs and budgets.

Employers thrive in the individual market, too

When employers purchase healthcare plans, they typically buy with the average employee in mind. This drives up costs, since they have to cover a broad range of needs with one-size-fits-all plans. These features often include large provider networks and benefits that many employees may not use, driving up costs, and reducing personalization.

Switching to the individual market can be transformative for employers. Bertolini highlighted the example of a company that switched from employer plans to individual market plans and cut their healthcare costs by nearly 30%

Given that half of Americans work for or own a small business, the upside impact of a more expansive individual market is significant.

Smart policy will help shape what’s possible

The individual market holds real promise, but it will take the right kind of policy to realize it.

New legislation making its way through Congress could help. Language in the Reconciliation bill adopted by the House in May paves the way for broader adoption of Individual Consumer Health Reimbursement Accounts (ICHRAs), which would allow employers to offer a fixed contribution for health coverage, giving employees the freedom to choose their own plans from the individual market. Similar efforts have also been underway on the state level.

Ohio, Georgia, and Texas, for example, also considered legislation this year to incentivize small employers to explore ICHRA for the first time by offering a per-employee state tax credit. Indiana passed this legislation effective in 2024.

The stakes here are high. As Bertolini pointed out, in 2024, Americans borrowed $74.9 billion to pay for their out of pocket medical costs. Making the individual market easier for more Americans to access could expand coverage in a way that fits modern working lives.

Want to go deeper? Explore more Oscar insights about the rise of the individual market.