risk-adjustment program sicker-than-average Related: 5 reasons the ACA risk-adjustment storm might blow over Noteworthy Preliminary 2017 ACA Risk-Adjustment Subtotals | |
| (in millions) | |
| Anthem | $ 260 |
| Health Care Service Corp. | $ 573 |
| Other Blues | $ 1,425 |
| BLUES | $ 2,258 |
| Centene | $ (621) |
| Kaiser | $ (554) |
| Molina | $ (853) |
| BIG NON-BLUES | $ (2,028) |
| Source: Appendix C to 2017 Benefit Year Risk Adjustment Summary Report - Table 3: Issuer-Specific Information for Individual and Small Group Markets (CMS) | |
Doubts
ACA risk-adjustment program basics
- Worries about what happens when issuers fail, or simply refuse to pay their risk-adjustment program bills.
- Whether the risk scores adequately reflect the relative risk of enrollees.
- Whether the issuer-level scoring approach is fair to new and rapidly growing plans, which may have little information about enrollees' health.
- Whether the issuer-level scoring formula is fair to plans with low average premiums.
Other report highlights
- The average monthly premium for all non-grandfathered, non-catastrophic individual major medical coverage increased 20 percent, to $472.
- The number of issuers in the ACA risk-adjustment program fell 7.8 percent, to 654.
- The number of issuers of non-grandfathered, non-catastrophic individual major medical coverage fell 20 percent, to 373.
- The number of issuers of non-grandfathered small-group major medical coverage fell 6.7 percent, to 515.
- About 21 percent of enrollees in the 2017 non-grandfathered, non-catastrophic individual major medical risk pool had at least one worrisome health condition included in the risk-scoring process, and 3.2 percent had three or more worrisome health conditions.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
