Description: This session discusses demographics of the uninsured & underinsured, needed core benefits, funding uncompensated care, state pools for high risk and near poor, the Massachusetts system, and the Kennedy-Waxman federal bills. From Record of the Society of Actuaries 1988 Vol. 14, No. 4B.

Description: This session discussion is about the effect of changes in medical practices and technology, effect of cost shifting, measurement and analysis and employers' perspective. From Record of the Society of Actuaries Vol. 15, No. 3A.

Description: This session discussion is about state-mandated health benefits. Who should decide and who should pay? The basis of making decisions, effect on insurance rates, impact on self-insurance, legislative process and timing of savings. From Record of Society of Actuaries Vol. 16, No. 1.

Description: This session discussion is about AIDS: Experience, trends and projections, medical and disability points of view, pricing, underwriting and epidemiologic implications and results of survey on current practices. From Record of Society of Actuaries Vol. 18, No. 1B.

Description: This article provides an overview of the key provisions and impacts of the Affordable Care Act's Cadillac Plan Excise Tax.

Description: There have been a variety of proposals related to expanding eligibility for Medicare, ranging from a publicly funded program to a full buy-in option. This session will explore the actuarial implications of various buy-in proposals and the potential impact that such policy changes could have on the health care market landscape. In particular, we will discuss the ways in which program eligibility requirements, plan designs, provider reimbursement arrangements, network design, rating rules, and subsidies could affect premium levels and membership volume in a Medicare buy-in market, as well as the potential side effects on providers and existing health care markets.

Description: Telehealth enables the delivery of health care services to patients that are not in the same location as providers. Over the past decade, telehealth has been used increasingly to complement face-to-face patient encounters, and is particularly important to addressing health care needs in rural areas. Recent regulatory catalysts, particularly in the Medicare Advantage program, have served to elevate the visibility and importance of telehealth in the overall health care delivery system. Starting in 2020, Medicare Advantage plans can offer any clinically appropriate physician services through telehealth as part of the standard Medicare benefit. Network adequacy standards can also be met via telehealth providers under certain programs. This presentation will cover the basics of what constitutes telehealth, and provide tangible demonstrations of telehealth technology (simulating variations mediums through which services are delivered). We will cover the what, the why, and the where (anywhere) of telehealth in 2020.

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: 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: This article describes a method that can be useful when re-fitting a risk score model to a population of only moderate size. Learn how to use concepts like ridge regression to train a model with partial credibility.