Typical individual major medical insurance enrollees may have been a little sicker in 2016 than in 2015.
Officials at the Centers of Medicare & Medicaid Services have published preliminary 2016 risk-level information in a new batch of data. CMS published the data to help insurers estimate how much cash they might get from, or pay into, the Affordable Care Act risk-adjustment program for 2016.
CMS had comparable program data for 20 states for 2015 and 2016.
The average monthly individual major medical premium in those states increased 11% between 2015 and 2015, to $417.
The “state average plan liability risk score” for plans in those states, or predicted enrollee risk level, increased to 1.525 in 2016, from 1.5 in 2016.
That small score increase translated into a risk level increase of just 1.7%.
When CMS posted similar information for 2015, for a slightly different list of states, it found that the average premium had increased about 4% between 2014 and 2015, to $380. The average “plan liability risk score,” or enrollee risk level, fell 6.3%.
Health insurers have been hoping that consumers’ growing familiarity with the ACA exchange system would help reduce enrollee risk levels by pulling healthier, younger people into plans.
The ACA imposes a penalty on many people who lack what the government classifies as adequate coverage for enough of the year. Insurers have been hoping fear of the penalty would push other young, healthy people into the market.
|How ACA Risk-Adjustment Program Numbers Change Between 2015 and 2016|
|AVERAGE MONTHLY PREMIUM||AVERAGE PLAN LIABILITY RISK SCORE|
|District of Columbia||324||325||0%||1.322||1.309||1.0%|
The members of Congress who wrote the ACA added the risk-adjustment program to help insurers cope with ACA rules that took effect in January 2014.