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Medicare Advantage: Part C and Some Part D Pricing Boot Camp for Health Actuaries

November 14 - 15, 2016
Marriott Portland Downtown Waterfront
Portland, OR


External Forces & Industry Knowledge Professional Values Technical Skills & Analytical Problem Solving

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This boot camp course has been offered annually for the past seven years and has emphasized Part C pricing with an increasing amount of material covering Part D in some years as well, should time allow. This year, the course is two days and will include some Part D pricing for MA-PD bids.

The course is aimed at participants from the beginner/intermediate level through the intermediate/advanced level. Beginners are welcome, but are expected to prepare more thoroughly prior to the course. All participants, regardless of level and prior experience, are expected to complete a non-trivial package of course reading and preparation in advance of the course.

During the course, participants will work with the Part C and Part D Bid Pricing Tools (BPTs). Each tool is a complex, multi-sheet Excel workbook that actuaries must develop and complete in order to submit a bid. All participants are expected to familiarize themselves with the structure and worksheets of the Part C BPT prior to the course, if they are not already.

This course will focus on pricing, the large body of product knowledge and regulatory requirements that affect MA-PD. Some HMO and/or PPO health pricing experience is a prerequisite for this course. Basic knowledge of the fee-for-service Medicare program is also expected-eligibility and benefit. Many advanced concepts in health pricing will be touched on during the course. There will be little time to slow down and explain concepts like coordination of benefits, member cost-sharing, trend and IBNR to those unfamiliar with them. This course is not intended as an entry-level course on health pricing for those who have no health pricing experience.

Medicare Advantage evolves annually. New rules are announced each year and product changes occur. These new developments do not typically lessen the actuaries' workload or otherwise make things easier during the limited time of the bid season. Presenters will cover the recent changes in the bid instructions and other regulations that affect BPT development. They will also discuss the relationship between the Part C and D BPTs and the Plan of Benefits Package (PBP).

There will be some class discussion. There will also be hands-on, in-class exercises conducted in small groups. Participants will need their laptops and will work with several peers to develop a BPT during the course. MA-PD is a rigorously regulated product and the pricing process is highly structured. Documentation, desk review and bid audit will be covered to some extent. Some discussion of professionalism will take place as it relates to bid development and certification, the code of conduct, relevant ASOPs, and the bid instructions.