Premium Stabilization Programs

The Affordable Care Act creates the risk adjustment, reinsurance and risk corridors programs (referred to as the premium stabilization programs), the cost-sharing reductions program, and Marketplace affordability programs such as advance payments of the premium tax credit. These programs are designed to provide consumers with affordable health insurance coverage, to reduce incentives for health insurance issuers to avoid enrolling sicker people, and to stabilize premiums in the individual and small group health insurance markets inside and outside the Marketplaces. Specifically, these programs are:

• Reducing the incentives for health insurance issuers to avoid enrolling people with pre-existing conditions: The permanent risk adjustment program will assist health plans that provide coverage to individuals with higher health care costs and will help ensure that those who are sick have access to the coverage they need.
• Stabilizing premiums in the individual market for health insurance: The transitional reinsurance program is a three-year program designed to reduce premiums and ensure market stability for issuers and thereby reduce premiums for enrollees in the individual market to ensure market stability with the implementation of new consumer protections in 2014.
• Protecting health insurance issuers against uncertainty in setting premium rates:  The temporary risk corridors program protects qualified health plans from uncertainty in rate setting from 2014 to 2016 by having the Federal government share risk in losses and gains.
• Assisting low and moderate-income Americans in affording health insurance on the Marketplaces: Advance payments of the premium tax credit will help eligible individuals pay their premiums and make coverage purchased through a Marketplace affordable for low- and middle-income consumers. The cost-sharing reduction program will further reduce the out-of-pocket spending for health services for low- and middle-income individuals, and Indians.

Announcements

Premium Stabilization Programs Data Reports

• June 17, 2015 - 2014 Benefit Year Transitional Reinsurance Program Pro Rata Adjustment to the National Coinsurance Rate (PDF)
• June 30, 2015 - Summary Report on Transitional Reinsurance Payments and Permanent Risk  Adjustment Transfers for the 2014 Benefit Year (PDF)
• September 17, 2015 - Updated Report “Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2014 Benefit Year” (PDF)
  • 2014 Geographic Cost Factors - Addendum to Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2014 Benefit Year (PDF)
• October 1, 2015 - Risk Corridors Payment Proration Rate for 2014 (PDF)
• October 9, 2015 - Early Reinsurance Payments for the 2015 Benefit Year (PDF)
• November 19, 2015 -  Risk Corridors Payment and Charge Amounts for Benefit Year 2014 Report (PDF)
• March 18, 2016 - Interim Summary Report on Risk Adjustment for the 2015 Benefit Year (PDF)
• June 17, 2016 - 2015 Benefit Year Transitional Reinsurance Program Pro Rata Adjustment to the National Coinsurance Rate (PDF)
• June 30, 2016 - Summary Report on Transitional Reinsurance Payments and Permanent Risk  Adjustment Transfers for the 2015 Benefit Year (PDF)
• December 6, 2016 - Amendment to the Summary Report on Transitional Reinsurance Payments and Permanent Risk  Adjustment Transfers for the 2015 Benefit Year  (PDF)
  • Appendix A to June 30, 2016 Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
    (Revised January 2018 to include induced demand factors)
  • Appendix B to June 30, 2016 Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
• September 9, 2016 - Risk Corridors Payments for 2015  (PDF)
• November 18, 2016 - Risk Corridors Payment and Charge Amounts for the 2015 Benefit Year (PDF)
• March 31, 2017* - Interim Summary Report on Risk Adjustment for the 2016 Benefit Year (PDF)
  • Appendix A: Interim Risk Adjustment State Averages with State Billable Member Months (XLSX)
  • Appendix B: HHS-operated Risk Adjustment Geographic Rating Factors (GCFs) (XLSX)
    
    *Updated April 11, 2017
• April 18, 2017
  • 2018 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF)  
  • 2018 Benefit Year Adult, Child and Infant Model Coefficients (Excel) (XLSX)  
• June 30, 2017 - Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2016 Benefit Year (PDF)  
  • Appendix A to June 30, 2017 Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
    (Revised January 2018 to include induced demand factors)
  • Appendix B to June 30, 2017 Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF ) (XLSX)  
  • Appendix C to June 30, 2017 Summary Report - Table 4: Issuer Specific Information (XLSX)  
  • Appendix D to June 30, 2017 Summary Report - Table 5: Issuer-Specific Information for Vermont Issuers (XLSX)  
  • Appendix E to June 30, 2017 Summary Report - Table 8: Default Risk Adjustment Charge (XLSX)  
  • Appendix F to June 30, 2017 Summary Report - Table 9: Default Charge Allocation (XLSX)  
• November 13, 2017*
  • Risk Corridors Payment and Charge Amounts for the 2016 Benefit Year (PDF)  
    *Updated November 15, 2017
• April 12, 2018 
  • 2019 Final HHS Risk Adjustment Model Coefficients (PDF)  
  • 2019 Benefit Year Final HHS Risk Adjustment Model Coefficients (XLSX)  
• April 27, 2018  Interim Summary Report on Risk Adjustment for the 2017 Benefit Year (PDF)  
  • Appendix A: Interim Risk Adjustment State Averages with State Billable Member Months (XLSX)  
  • Appendix B: HHS-operated Risk Adjustment Geographic Rating Factors (GCFs) (XLSX)  
• July 9, 2018 Summary Report on Permanent Risk Adjustment Transfers for the 2017 Benefit Year
  • Appendix A to 2017 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)  
  • Appendix B to 2017 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)  
  • Appendix C to 2017 Benefit Year Risk Adjustment Summary Report - Table 3: Issuer-Specific Information for Individual and Small Group Markets (XLSX)  
  • Appendix D to 2017 Benefit Year Risk Adjustment Summary Report - Table 4: Issuer-Specific Information for Merged Market States (XLSX)  
  • Appendix E to 2017 Benefit Year Risk Adjustment Summary Report - Table 7: Default Risk Adjustment Charge (XLSX)  
  • Appendix F to 2017 Benefit Year Risk Adjustment Summary Report - Table 8: Default Risk Adjustment Charge Allocation (XLSX)  
• November 30, 2018 Updated Summary Report on Permanent Risk Adjustment Transfers for the 2017 Benefit Year (PDF)  
  • Appendix E to 2017 Benefit Year Risk Adjustment Summary Report – Updated Table 7: Default Risk Adjustment Charge (XLSX)  
  • Appendix F to 2017 Benefit Year Risk Adjustment Summary Report – Updated Table 8: Default Risk Adjustment Charge Allocation (XLSX)  
• March 22, 2019 - Interim Summary Report on Risk Adjustment for the 2018 Benefit Year (PDF)
  • Appendix A: Interim Risk Adjustment State Averages with State Billable Member Months (XLSX)  
  • Appendix B: HHS-operated Risk Adjustment Geographic Rating Factor (GCF) (XLSX)  
• May 31, 2019 - 2017 Benefit Year HHS Risk Adjustment Data Validation Results (PDF)
  • Appendix A Program Benchmark Metrics 2017 Benefit Year HHS-RADV (XLSX)
  • Appendix B Estimated 2018 RA Market Weighted Average Risk Score Adjustments from 2017 RADV (XLSX)  
  • Appendix C Estimated 2017 RA Market Weighted Average Risk Score Adjustments from 2017 HHS-RADV (Exiting Issuers) (XLSX)  
  • Appendix D 2017 Benefit Year HHS-RADV HCC Group Definitions (XLSX)   
    
    
• June 28, 2019 - Summary Report on Permanent Risk Adjustment Transfers for the 2018 Benefit Year (PDF)
  • Appendix A to 2018 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)  
  • Appendix B to 2018 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)  
  • Appendix C to 2018 Benefit Year Risk Adjustment Summary Report - Table 4: Issuer-Specific Information for Non-Merged Market Issuers (XLSX)  
  • Appendix D to 2018 Benefit Year Risk Adjustment Summary Report - Table 5: Issuer-Specific Information for Merged Market Issuers (XLSX)  
  • Appendix E to 2018 Benefit Year Risk Adjustment Summary Report - Table 8: Default Risk Adjustment Charge (XLSX)  
  • Appendix F to 2018 Benefit Year Risk Adjustment Summary Report - Table 9: Default Risk Adjustment Charge Allocation (XLSX)  
• August 1, 2019 - Summary Report of 2017 Benefit Year Risk Adjustment Data Validation Adjustments to Risk Adjustment Transfers (PDF)
  • Appendix A to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 2: Issuer-Specific 2017 HHS-RADV Adjustments to 2018 Risk Adjustment Transfers for Non-Merged Market States (XLSX)  
  • Appendix B to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 3: Issuer-Specific 2017 HHS-RADV Adjustments to 2018 Risk Adjustment Transfers for Merged Market States (XLSX)  
  • Appendix C to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 4: Issuer-Specific 2017 HHS-RADV Adjustments to 2017 Risk Adjustment Transfers for Non-Merged Market States (XLSX)  
  • Appendix D to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 6: HHS Default Data Validation Charge (XLSX)  
  • Appendix E to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 7: HHS Default Data Validation Charge Allocation (XLSX)  
  • Appendix F to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - HHS Operated Risk Adjustment Program State-Specific Data for 2018 (XLSX)
  • Appendix G to 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - HHS Operated Risk Adjustment Program State-Specific Data for 2017 (XLSX)   

Risk Adjustment State Flexibility Requests

• January 17, 2019 Requests for the 2020 Benefit Year
  • Alabama: Small Group Market Request (Document 1 (PDF), Document 2 (PDF))