Description: Issues relating to the1998 Balanced Budget Act BBA on Medicare Supplement Carriers. Discusses High-Deductible options, open enrollment provisions, pre-existing condition limitations, new provider payment methods and preventive benefits Issue No. 36.

Description: This article reviews the Medicare Prescription Drug, Improvement and Modernization Act and the impact the legislation has had on Medicare Supplement plans, policies and the changes to the model regulation. From Health Section Newsletter, March 2005, Issue No. 49.

Description: This article provides an introduction to the Medicare Prescription Drug, Improvement and Modernization Act of 2003 and looks at how the Medicare prescription drug plan will affect the commercial market as well as, what PDPs will offer for benefits and if any will offer supplemental benefits. From Health Section News, March 2005, Issue No. 49.

Description: In this paper, we shine a light on the global public health epidemic of intimate partner violence (IPV). This first paper presents background information on the problem with a focus on health and economic impacts for the actuarial audience

Description: Two years ago, before COVID-19 changed everything about how we provide and receive health care, telehealth was largely provided by third-party vendors to treat a narrow range of acute one-and-done conditions. The value proposition was simple: a fast and easy member experience would drive satisfaction and engagement; high member satisfaction and engagement would drive health plan savings and member retention. Clearly, from the perspective of utilization, telehealth—as a viable alternative to in-person care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance, the health care system is in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and better outcomes than it was two years ago. But in the wake of the pandemic, it is just as clear to us that if telehealth is to live up to its full potential, some changes are needed. The rest of this article presents five ideas for improving the delivery of telehealth going forward.

Description: Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event. Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event.

Description: ACA risk adjustment has now been in play for years. The original intent of risk adjustment was to help stabilize the market through measuring risk levels of each issuer. However, the risk adjustment program may have introduced additional uncertainty due to annual market shifts and model changes, making risk adjustment estimation is a difficult task. This article analyzes the results over time, including impacts from market changes and model changes.

Description: Interview of people knowledgeable about risk adjustment and the use of social determinants of health with that context for Medicaid.

Description: Congress has been debating a revision to Medicare Advantage payments including limiting payments to the Medicare Fee-For-Service FFS cost. A county-specific impact study to the benchmark payment rates for each county nationally based on the FFS limitation criteria was performed. This article includes results for Florida, California, Pennsylvania and New York.

Description: This article on IPV focuses on IPV during the COVID-19 pandemic