Description: In April 2018, the Centers for Medicare & Medicaid Services (CMS) published a revised definition of primarily health related (PHR) benefits as applicable to Medicare Advantage (MA) organizations.

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: 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: Read the December 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Interview with Cori Uccello, senior health fellow for the American Academy of Actuaries.

Description: Update on Health Section research projects and topics, including health care reform, complexity science, and strategic planning.

Description: What are Biosimilar drugs? Are they the same as generic drugs? What potential impact might Biosimilars have in the United States prescription drug landscape and it’s economics? This article explores those questions as well as exclusivity and interchangeability.

Description: When designing and pricing a healthcare product, it is not only important to know how to model frequency and severity, but it is essential to understand human behavior. Of course, the issue of anti-selection in medical insurance is well known as individuals know more about their health and prior expenditures than an insurer does. This type of behavior is certainly rational, and to be expected.

Description: Read the February 2020 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?