CMS reports on risk-adjustment program results for 2018 benefit year

The Centers for Medicare & Medicaid Services Friday released a report on the final estimated results of the permanent risk-adjustment program for the 2018 benefit year. The program, created by the Affordable Care Act, transfers funds in the individual and small group health insurance markets from health plans with lower-risk enrollees to plans with higher-risk enrollees to spread the financial risk and help stabilize premiums. A total of 572 issuers participated in the program for the 2018 benefit year, down from 654 issuers in 2017. The absolute value of risk-adjustment transfers across markets (excluding the high-cost risk pool) was about 7% of total premiums, down from 8% in the 2017 benefit year, CMS said. Among other changes to the program for the 2018 benefit year, the risk-adjustment methodology included a high-cost risk pool, which reimburses issuers for 60% of an enrollee’s aggregated paid claims costs exceeding $1 million. A total of 217 issuers received a high-cost risk pool payment, CMS said. To access the report and associated data, visit https://www.cms.gov.