Description: The use of Risk Adjustment in Medicare Advantage (MA) has come under scrutiny due in part to a higher rate of increase of costs of its participating Health plans relative to traditional Medicare despite statutory requirements that reimbursement for these two programs must be actuarially equivalent.

Description: This is Part 2 of 2 on changes affecting Medigap insurers. It focuses on marketing and regulatory differences between Medigap and Medicare Advantage that affect the competitiveness of Medigap plans.

Description: Pharmacy prices are top of mind for many consumers, policymakers, and payers. While there have been many efforts to reduce pharmacy costs over the years, many believe these efforts only helped us cope with the symptoms of the problem without providing a comprehensive cure for the underlying causes of this problem. The Society of Actuaries Health Section sponsored this Pharmacy Partnership Forum to gather multi-disciplinary experts in the pharmacy ecosystem. This report shares the insights and learnings that emerged from this group of health economics outcomes researchers, clinical pharmacists, medical doctors, health actuaries, benefits consultants and brokers, and their collective thoughts on advancing this exploration for society’s benefit.

Description: This report is presented in the form of a Tableau dashboard and is the sixth public release from this report series and contains the results of an excess mortality analysis for the fourth quarter of 2021. Data from 30 companies representing approximately 69% of the industry’s face amount inforce were included in the analyses in this report. A total of 3.2 million death claims from individual life policies from 2015 through December 31, 2021 make up the basis of the analyses. The report also compares the experience under COVID-19 of the insured population versus the general population.

Description: This report is a comprehensive survey of existing literature on mortality and race and ethnicity in the United States, examining disparities in mortality rates among different racial and ethnic groups. It explores factors influencing mortality differentials, including socioeconomic status, health care access, and other relevant aspects.

Description: This report gives an update on the Getzen Model of Long-Run Medical Cost Trends for 2025-2035+, providing insights on key considerations, input parameters, and projections. It includes observations on long-term medical cost trends, budgetary resistance, and regulatory impacts on healthcare expenditures.

Description: 2014 marked a new beginning for small group(SG) health insurance market ushered in with adjusted community rated products priced from a single risk pool. It was anticipated that the mandated pooling of the risk would result in higher rates, especially for healthier groups. It is the aim of this article to show whether that view bears out in the actual market rates and if it is higher, then by how much. The article provides a point in time(1st quarter 2025) comparison of premium rates under two segments of the small group market, namely Qualified Health Plans(QHP) available under the small group ACA market versus self-insured Multiple Employer Welfare Arrangements(MEWA) plans.

Description: Connect with the health actuarial community -- explore innovative solutions, advance your career, and participate in engaging, interactive events. Join the industry’s leading actuaries, analysts and professionals to network and discuss the impacts of the latest marketplace factors and trends.

Description: Connect with the health actuarial community -- explore innovative solutions, advance your career, and participate in engaging, interactive events. Join the industry’s leading actuaries, analysts and professionals to network and discuss the impacts of the latest marketplace factors and trends.

Description: This article summarizes the winners of the Product & Process Innovative Marketing Awards that were presented at the February 2005 Professional Insurance Marketing Association PIMA annual meeting in Tucson.