The Center for Consumer Information & Insurance Oversight
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)
- 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)
- Appendix A to June 30, 2016 Summary Report – HHS Risk Adjustment Program State-Specific Data (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)
- April 18, 2017
- 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)
- Appendix A to June 30, 2017 Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
- November 13, 2017*
- Risk Corridors Payment and Charge Amounts for the 2016 Benefit Year (PDF)
*Updated November 15, 2017
- Risk Corridors Payment and Charge Amounts for the 2016 Benefit Year (PDF)
- April 12, 2018
- April 27, 2018 Interim Summary Report on Risk Adjustment for the 2017 Benefit Year (PDF)
- 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)
- March 22, 2019 - Interim Summary Report on Risk Adjustment for the 2018 Benefit Year (PDF)
- 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))
Updates
- November 5, 2019 FAQ: Quality Rating Information Bulletin’s (Quality Bulletin’s) Display Guidelines for Direct Enrollment (DE) Entities
- November 1, 2019 Enhanced Direct Enrollment Approved Partners (Updated)
- September 11, 2019 FAQ: Enhanced Direct Enrollment Participation Requirements for Non-Issuer of a Primary EDE Entity Environment
- August 15, 2019 Quality Rating Information Bulletin for Plan Year 2020 Health Insurance Exchanges Quality Rating System (QRS) for Plan Year (PY) 2019: Results at a Glance
- April 18, 2019 CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020 Final 2020 Letter to Issuers on Federally-facilitated Exchanges Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment
- April 4, 2019 Guidance on Unified Rate Review Timeline: Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2020
- March 19, 2019 2020 Final Actuarial Value Calculator 2020 Final Actuarial Value Calculator Methodology
- March 6, 2019 CMS-9921-NC: Request for Information Regarding the Sale of Individual Health Insurance Coverage Across State Lines Through Health Care Choice Compacts
- February 28, 2019 Section 1332 Pass-through Funding Tools and Resources