Description: Conditions and required solvency standards of federal waiver to PSOs to provide Medicare+Choice products. Effect on providers, beneficiaries and employers. Issue No. 36

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: Changes in CMS requirements for 2011 Medicare Part D plans aimed at reducing confusion surrounding the PDP selection process by making plan differences more visible to seniors. Carriers have responded by making the most significant changes in plan offerings since the program's inception, which is expected to result in membership shifts.

Description: Background on, and best practices guidelines for dealing with, bid reviews and audits for Medicare Advantage plans.

Description: This article compares the Prescription Drug Plan (PDP) market to the commercial individual market exchanges included in the Affordable Care Act. PDP carrier actions to date could help predict certain aspects of the exchange market.

Description: Republicans have promised to repeal and replace the Affordable Care Act for years. Now that they have power, what will Republican health care reform look like?

Description: What you need to know about risk scores to be competitive in the Medicare Advantage market.

Description: Issues relating to the1998 Balanced Budget Act BBA on Medicare Supplement Carriers. Discusses High-Deductible options, open enrollment provisions, pre-existing condition limitations, new provider payment methods and preventive benefits Issue No. 36.

Description: This article discusses future benchmarks of Medicare and Medicare's rising costs and its relativity to the actuarial profession.

Description: The editors of Health Watch have made health care reform the focus of the Sepctember 2009 issue, and provide an introduction to the issue's contents.