Consumers in the individual and small group health insurance markets want to understand the future of their health insurance. This paper by Milliman actuaries Esther Blount and Andrew Bourg highlights the steps the Patient Protection and Affordable Care Act (ACA) has in place to promote consumer knowledge in the individual market and the pros and cons of removing such initiatives.
Disparities in results between the cost-sharing reduction (CSR) advance payment formula and the actual CSR payment can strain an insurer’s cash flow. Insurers can request a revised payment from the U.S. Department of Health and Human Services (HHS) if they can demonstrate a substantial difference during the plan year supported by an actuarial certification. In this paper, Milliman consultants Esther Blount, Frederick Busch, and Scott Weltz discuss what is required to receive more accurate payments throughout the year.