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Objectivity matters. Today, more than ever.

Independent for over 70 years, Milliman delivers market-leading services and solutions to clients worldwide. With no agenda, other than getting it right.

Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance.

News

  • 19 February 2019 — Captive Review
    The 2018 Captive Review Power 50
  • 14 September 2018 — Wall Street Journal
    Florence flood threat heightened by underinsured homeowners
See All News

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We offer unmatched depth and breadth of knowledge in long-term care.

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Expanding access to quality healthcare for a California community.

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Recent stories

  • See the forest for the trees
  • Remaining a vibrant domicile
  • Milliman FRM Market Commentary: December 2019
  • Monthly Benefit News and Developments, December 2019
Critical Point podcast

A Milliman podcast covering topics in health, benefits, and more

insightMilliman insight

All insightHealthcareEmployee Benefits and InvestmentInsuranceRisk Management and Financial Services
The elusive nature of private exchanges
The elusive nature of private exchanges
Telemedicine and the long-tail problem in healthcare
Telemedicine and the long-tail problem in healthcare
Plan design strategies in the ACA marketplace
Plan design strategies in the ACA marketplace

Affordable Care Act research

  • Summary of individual market enrollment and Affordable Care Act subsidies

    By Paul R. Houchens, Jason A. Clarkson, Zachary Fohl | 26 November 2019

    These state profiles summarize insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2019 open enrollment period and estimated 2019 effectuated enrollment.

  • Has the ACA death spiral kicked the bucket?

    By Erik Huth, Peter Fielek | 22 July 2019

    This article reviews ACA rates, enrollment, and morbidity to determine the likelihood of a death spiral occurring in the ACA marketplace.

  • Could 2019 be the year of MLR rebates for ACA issuers in the individual market?

    By Esther M. Blount, Michelle Klein, Alison Fasching | 04 March 2019

    As medical loss ratios (MLR) decrease, individual ACA issuers need to start thinking about something that has been mostly irrelevant to them until now—MLR rebates.

  • How will EDGE affect your 2019 ACA Risk Adjustment Transfer?

    By Zachary M. Davis, Phil Ellenberg, Brian A. Sweatman | 02 August 2018

    This paper and the accompanying interactive exhibits show the coefficients from the 2019 CMS HHS-HCC commercial risk adjustment model and compare how ACA experience from 2016 EDGE data incorporated into the 2019 model will affect risk scores, which have a direct impact on an issuer’s risk adjustment transfer.

  • 2018 summary of individual market enrollment and Affordable Care Act subsidies

    By Paul R. Houchens, Jason A. Clarkson, Zachary Fohl | 31 July 2018

    A profile of the individual health insurance market for each state and the District of Columbia, summarizing insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplace, incorporating recently released data from the 2018 open enrollment period.

  • Why accurate claims coding for MSSP ACOs has become increasingly important

    By Jonah Broulette, Noah Champagne, Kathryn V. Fitch | 26 June 2018

    This brief explains how benchmark year 3 risk scores affect the benchmark calculation for Medicare Shared Savings Program (MSSP) renewals, presents an overview of the prior and new MSSP benchmark calculations, and illustrates how the change can affect an accountable care organization’s benchmark under various scenarios.

  • The impact of the $0 individual mandate penalty

    By Andrew Bourg, Fritz Busch, Stacey V. Muller | 08 June 2018

    Understanding the impact of the $0 individual mandate penalty on the health insurance risk pool is important to both insurers offering ACA-compliant products and state policymakers evaluating its alternatives.

  • Commercial health insurance: Overview of 2016 financial results and emerging enrollment and premium data

    By Paul R. Houchens, Jason A. Clarkson, Jason Melek | 17 May 2018

    This report provides a detailed review of the commercial health insurance industry’s financial results in 2016 and evaluates changes in the market’s expense structure and enrollment prior to relative years.

  • The individual mandate repeal: Will it matter?

    By Fritz Busch, Paul R. Houchens | 01 March 2018

    With the passage of the Tax Cuts and Jobs Act of 2017, there are renewed concerns related to the stability of the individual market.

  • Removal of Actuarial Value requirements for ACA-compliant pediatric standalone dental plans

    By Joanne E. Fontana | 19 January 2018

    This article reviews a significant change affecting dental benefit plans—namely, removing Actuarial Value (AV) requirements for ACA-compliant standalone pediatric dental plans—which will be critical for dental issuers to understand and act on as the 2019 pricing cycle begins.

See More Articles

  • 05 January 2018

    EHB, MLR, and risk adjustment: Stakeholder considerations on the 2019 proposed Notice of Benefit and Payment Parameters

    This paper focuses on three proposed changes in the Notice of Benefit and Payment Parameters for 2019 that would likely affect premiums in the individual and small group markets.

  • 22 December 2017

    Considerations regarding the Next Generation ACO stop-loss methodology

    This report identifies several important considerations regarding the impact of the stop-loss provision on participating Next Generation accountable care organizations.

  • 16 November 2017

    Are health carriers ready to explain the 2018 age curve?

    For the first time since the inception of the Patient Protection and Affordable Care Act in 2014, the federal government is changing the age curve for ages 0 to 20, effective January 1, 2018.

  • 15 November 2017

    Law and Executive Order: A look at how President Trump's executive order on healthcare impacts the ACA's small group and individual markets

    This paper summarizes the Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States and analyzes key considerations and potential impacts for commercial health plans.

  • 08 November 2017

    Individual stop-loss is now optional for Next Generation ACOs

    For some Next Generation Accountable Care Organizations, the choice between an annual financial reconciliation based upon capped claims or uncapped claims could have a significant impact.

  • 08 November 2017

    Next Generation ACO Program financial results for 2016

    This paper describes the financial results of the Next Generation Accountable Care Organizations program.

  • 17 October 2017

    The differences are in the details: Considerations for comparing 30-day unplanned readmission rates

    This article identifies key elements that should be considered when evaluating readmission rates across populations or when comparing readmission rates with different methodologies.

  • 28 September 2017

    What predictive analytics can tell us about key drivers of MSSP results

    This article provides insight into the 2015 gross savings/(losses) achieved by accountable care organizations in their third performance year of the Medicare Shared Savings Program.

Affordable Care Act research

  • Accountable Care Organizations
  • State Exchanges
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  • Featured videos

    • Medicaid - ThumbnailUnderstanding healthcare costs: Medicaid(4:44)
    • ACO Part2 - ThumbnailHealthcare costs and accountable care organizations(3:58)
    • ACO Exchange - ThumbnailHealth exchanges: Key issues for states(6:14)
    See all video
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For more than seven decades, Milliman has combined technical expertise with business acumen to create elegant solutions for our clients. 

Today, we are helping companies take on some of the world's most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation.


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