Podcast Center
Video Center
Webcasts
Resource Center
Events
April 20, 2017 at 11:53 PM
Federal regulators have revamped the tables commercial, individual and small-group health plans use to estimate how much covering sick enrollees will cost.
The Center for Consumer Information & Insurance Oversight published the new tables on the web earlier this week. The new tables give numbers that rate the estimated cost of covering most types of healthy people a little lower. The tables rate the estimated cost of covering many types of sick people much lower.
The risk factor for the costliest enrollees in the tables, severely ill, severely premature babies, will fall to 287.667 in 2018 for families with mid-level silver plan coverage, from 334.332 for 2017.
In a separate table for adults, which includes only risk factors for conditions, not condition severity, the highest risk factor is for adults with hemophilia. The risk factor for that condition will fall to 41.379 in 2018 for patients with silver plan coverage, from 45.940 for 2017.
Issuers of individual and small-group plans need the risk factor tables to participate in the Affordable Care Act risk-adjustment program. The program is supposed to protect plans from covering more than their fair share of sick enrollees. Program managers at CCIIO take cash from plans with low-risk enrollees and send the cash to plans with high-risk enrollees.
(Related: CO-OP Explains Why It Thinks ACA Risk-Adjustment Is Nuts)
If the current U.S. health insurance system survives, the new risk factor tables could make covering healthy people more attractive in 2018, and covering sick people less attractive.
To participate in the ACA risk-adjustment program, the coverage issuers calculate risk scores for each patient.
