Becker's Healthcare November 13, 2023
ACA marketplace risk adjustment payments are working as intended, an analysis from Oliver Wyman, commissioned by the Blue Cross Blue Shield Association, found.
The report compared insurers’ average claim costs to the risk adjustment payments it received, and found insurers with higher costs received more risk adjustment funds.
The ACA risk adjustment system is designed to even out risk between insurers on the exchange, to ensure insurers are not incentivized to avoid enrolling higher-acuity members.
Oliver Wyman researchers concluded the risk adjustment payment system does not disadvantage smaller insurers or new insurers entering the market, though the system does underpay for the highest-cost claims.
Two high-profile insurers have left the ACA market in the past year,...
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