- 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.
- EHB, MLR, and risk adjustment: Stakeholder considerations on the 2019 proposed Notice of Benefit and Payment Parameters
By Victoria Boyarsky, Rong Yi | 05 January 2018
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.
- Considerations regarding the Next Generation ACO stop-loss methodology
By Hugh Larson, Timothy J. Wilder, Annie Man, Coleen Young | 22 December 2017
This report identifies several important considerations regarding the impact of the stop-loss provision on participating Next Generation accountable care organizations.