Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: This discussion reviews the effect expected from legislation in the U.S. to finance the cost of medical care of the aged. From Transactions of Society of Actuaries 1961, Vol. 13, Pt. 2.

Description: Summary of the National Conference on Group Practice of Medicine, held in Chicago from October 19-21, 1967 to explore means for stimulating the group practice of medicine.

Description: MHPAEA prohibits health plans from imposing financial requirements or treatment limitations on behavioral health benefits that are more restrictive than those applied to medical and surgical benefits. MHPAEA's regulations define treatment limitations to include nonquantitative treatment limitations (NQTLs), which are benefit design features that are not numerical, but otherwise limit the scope or duration of benefits.

Description: HIV is still a big public health concern, but there are therapies available to prevent infection before and immediately after exposure. As legislatures and the USPSTF considers adding these therapies to the list of preventive care covered without cost share, actuaries will need to estimate the impact on their care cost. The presenters will share an actuarial tool kit to estimate the impact of covering PrEP and PEP for different populations. Examples are provided and discussion is welcome.

Description: Panel discussion of prospects for cost containment of, and alternatives to, fee-for-service health care, and management of health care under national health insurance. Discussion points include cost containment devices, HMOs, economic impact, cost escalation, self-insurance, stop-loss, claims administration, loss of state premium taxes, and Phase 3 tax problems under NH1.

Description: Panelists discuss the future of prospective payment in Medicare, sequels to the Omnibus Budget Reconciliation Act, the Deficit Reduction Act, COBRA, fallout from the administration's Catastrophic Illness Study, and the evolution of the voucher proposal. From the 1987 Record of Society of Actuaries, Vol. 13, No. 1.

Description: Overview of research project to investigate the extent of funding of public government retiree health programs.

Description: A proposal to reform current health care market, from a 'preferred payer' system, in which Medicare and Medicaid pay less than the true cost while others must then pay more, to a 'value for money' system. This would be achieved by requiring providers to bill all patients the same rate for the same services, with a standard bundling format to make all providers' rate differences transparent. Differences between billed charges and what Medicare pays would be made up by the Medicare patient, rather than subsidized by those outside of Medicare.