Description: This article compares the Prescription Drug Plan (PDP) market to the commercial individual market exchanges included in the Affordable Care Act. PDP carrier actions to date could help predict certain aspects of the exchange market.

Description: Summary of House of Representatives Tri-Committee Bill – H.R. 3200.

Description: Essay states a competing American ideals for the U.S. Health care system include free markets which foster competition, cost effectiveness and quality health care vs.public and private assistance which provides health care independent of a person’s financial means.

Description: The always popular Medicaid Hot Topics session is back with discussions from an expert panel on the most riveting Medicaid topics of the year. These could include the following: • Medicaid Fiscal Accountability Proposed Regulations• Tennessee's Block Grant Proposal• ACA court battles: What are the potential impacts on Medicaid? • Pass-through payments are converting to directed payments: What is changing?• And more current topics of interest to Medicaid actuariesMedicaid is dynamic and it is difficult to stay current on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients.

Description: This article makes organizations entering the MA market aware of the star rating climate, as well as short- and long-term star rating & revenue considerations.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Discussion of the following topics pertaining to disability income and other health insurance: 1. What portions of the loss of income and of the expenses incurred are properly insurable? 2. What special problems are encountered in providing suitable coverage for the following: a Employees and dependents eligible under Group plans b Individuals employed or not employed and their dependents ineligible under Group plans c Aged persons. 3. Methods for companies to meet the problems of overinsurance arising from duplication of coverage or from other causes?

Description: The American Academy of Actuaries is engaged in several projects that proactively examine the future status of the Medicare Program. This session presents the findings that have resulted from these efforts. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This article examines the concept of Actuarial Value, especially as it applies to the Medicare plan of benefits. It discusses the cost-sharing responsibility of Medicare beneficiaries and the means by which they mitigate this risk.

Description: This session from the 1983 SOA Vancouver Meeting discusses national health policy issues in the U.S. and the impact of these issues on the private health insurance business. Issues include health insurance for the unemployed, non-paying patients and cost shifting, competition versus regulation and DRG prospective pricing for Medicare.