According to the U.S. Department of Health and Human Services (HHS), the risk adjustment program operated smoothly for the 2020 benefit year. The risk adjustment program is working as intended by more evenly spreading the financial risk carried by issuers that enrolled higher-risk individuals in a particular state market risk pool, thereby protecting issuers against adverse selection and supporting them in offering products that serve all types of consumers.
- Participants in the risk adjustment program include health insurance issuers offering plans in the individual or small group market, with the exception of: grandfathered health plans, group health insurance coverage described in 45 C.F.R. § 146.145(b), individual health insurance coverage described in 45 C.F.R. § 148.220, and any plan determined not to be a risk adjustment covered plan in the applicable Federally certified risk adjustment methodology.
- A total of 576 issuers participated in the risk adjustment program for the 2020 benefit year, of which 569 received a risk adjustment state transfer (excluding the high-cost risk pool), and 8 received a default risk adjustment charge, in at least one risk pool. For the 2019 benefit year, 561 issuers participated in the risk adjustment program.
- Nationwide, the absolute value of risk adjustment state transfers across all state market risk pools (excluding the high-cost risk pool) was about 7.5 percent of total premiums, very similar to the 2019 benefit year transfers, which was 7 percent of total premiums.
Director, Product Strategy
Centauri Health Solutions, Inc.