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

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

Description: CMS has pioneered innovative strategies for Medicare and Medicaid to address Social Determinants of Health (SDOH). Employers can learn from these models to implement similar approaches for their employee populations. Learn how employers can understand and address SDOH, the incentives for doing so, and the broader benefits.

Description: This report outlines a framework for interpretable machine learning algorithms for detecting fraud in health insurance. It discusses the challenges of using black-box machine learning models in the insurance industry and proposes various interpretable methods to enhance transparency and understanding.

Description: This report examines the demographic, medical, and pharmaceutical profiles of HIV-positive individuals in Medicare and how their needs differ from the general Medicare population.

Description: Explore the findings from the research paper recently released by Milliman and the SOA, highlighting the growing need for support of informal/family caregivers. We will discuss both quantitative and qualitative data that illustrates not only the cost and burgeoning need, but the mental/emotional stressors that come along with this work.

Description: Learn more about Health Care Sharing Ministries (HCSMs) and their functionality as health insurance. These nonprofit companies pool money from participating members to assist with members' healthcare coverage. Further exploring HCSMs, some of the offered arrangements of this plan operate differently and with a unique regulatory framework. HCSM enrollment has grown 1000% since solidification as a law in the ACA. By signing up for this webcast, you can discover why HCSMs are becoming a key component of the individual market in some states.