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)
  • 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)
  • 2018 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF)
  • 2018 Benefit Year Adult, Child and Infant Model Coefficients (Excel) (XLSX)
  • 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)
  • Risk Corridors Payment and Charge Amounts for the 2016 Benefit Year (PDF)
    *Updated November 15, 2017
  • 2019 Final HHS Risk Adjustment Model Coefficients (PDF)
  • 2019 Benefit Year Final HHS Risk Adjustment Model Coefficients (XLSX)
  • Appendix A: Interim Risk Adjustment State Averages with State Billable Member Months (XLSX)
  • Appendix B: HHS-operated Risk Adjustment Geographic Rating Factors (GCFs) (XLSX)
  • 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)
  • 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)
  • Appendix A: Interim Risk Adjustment State Averages with State Billable Member Months (XLSX)
  • Appendix B: HHS-operated Risk Adjustment Geographic Rating Factor (GCF) (XLSX)
  • 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)
    
  • 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)
  • 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)
  • Appendix A: Interim 2019 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX)
  • Appendix B: HHS-operated Interim 2019 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
  • Appendix A: National Program Benchmarks - 2018 Benefit Year HHS-RADV Compared to 2017 Benefit Year HHS-RADV (XLSX)
  • Appendix B: Estimated 2019 Benefit Year RA Market Weighted Average Risk Score Adjustment Factors from 2018 Benefit Year HHS-RADV Results (XLSX)
  • Appendix C: Estimated 2018 Benefit Year RA Market Weighted Average Risk Score Adjustment Factors from 2018 Benefit Year HHS-RADV Results (Exiting Issuers) - "Not Applicable for 2018 Benefit Year"
  • Appendix D: 2018 Benefit Year HHS-RADV HCC Group Definitions (XLSX)
  • Appendix A to 2019 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
  • Appendix B to 2019 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
  • Appendix C to 2019 Benefit Year Risk Adjustment Summary Report - Table 4: Issuer-Specific Information for Non-Merged Market Issuers (XLSX)
  • Appendix D to 2019 Benefit Year Risk Adjustment Summary Report - Table 5: Issuer-Specific Information for Merged Market Issuers (XLSX)
  • Appendix E to 2019 Benefit Year Risk Adjustment Summary Report - Table 8: Default Risk Adjustment Charge (XLSX)
  • Appendix F to 2019 Benefit Year Risk Adjustment Summary Report - Table 9: Default Risk Adjustment Charge Allocation (XLSX)
  • Appendix G to 2019 Benefit Year Risk Adjustment Summary Report - Average Plan Liability Risk Score by State, Market, and Metal Level (XLSX)
  • Appendix H to 2019 Benefit Year Risk Adjustment Summary Report – Distribution of Enrollees by Number of HCCs, by State and Market (XLSX)

  *U pdated August 05, 2020 – The Summary Report on Permanent Risk Adjustment Transfers for the 2019 Benefit Year was updated to correct typos in Table 4 that impacted the transfer amounts for small group issuers in Washington. However, Appendix C was not impacted and reflects the correct results.

  • August 18, 2020- Summary Report of 2018 Benefit Year Risk Adjustment Data Validation Adjustments to Risk Adjustment Transfers (PDF)
    • Appendix A - 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - Tables 3a through 3c: Issuer-Specific 2018 HHS-RADV Adjustments to 2019 Risk Adjustment Transfers for Non-Merged Market States (XLSX)
    • Appendix B - 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 4: Issuer-Specific 2018 HHS-RADV Adjustments to 2019 Risk Adjustment Transfers for Merged Market States (XLSX)
    • Appendix C - 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - HHS Operated Risk Adjustment Program State-Specific Data for 2019 (XLSX)
    • Appendix A to Updated 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 Updated 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 Updated 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 Updated 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 6: HHS Default Data Validation Charge (XLSX)
    • Appendix E to Updated 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 7: HHS Default Data Validation Charge Allocation (XLSX)
    • Appendix F to Updated 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - HHS Operated Risk Adjustment Program State-Specific Data for 2018 (XLSX)
    • Appendix G to Updated 2017 Benefit Year Risk Adjustment Data Validation Adjustment Report - HHS Operated Risk Adjustment Program State-Specific Data for 2017 (XLSX)
    • Appendix A: Interim 2020 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX)
    • Appendix B: HHS-operated Interim 2020 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix A to 2020 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
    • Appendix B to 2020 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix C to 2020 Benefit Year Risk Adjustment Summary Report – Table 4: Issuer-Specific Information for Non-Merged Market Issuers (XLSX)
    • Appendix D to 2020 Benefit Year Risk Adjustment Summary Report – Table 5: Issuer-Specific Information for Merged Market Issuers (XLSX)
    • Appendix E to 2020 Benefit Year Risk Adjustment Summary Report – Table 8: Default Risk Adjustment Charge (XLSX)
    • Appendix F to 2020 Benefit Year Risk Adjustment Summary Report – Table 9: Default Risk Adjustment Charge Allocation (XLSX)
    • Appendix A to Updated 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 2: Issuer-Specific 2018 HHS-RADV Adjustments to 2019 Risk Adjustment Transfers for Non-Merged Market Risk Pools (XLSX)
    • Appendix B to Updated 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 3: Issuer-Specific 2018 HHS-RADV Adjustments to 2019 Risk Adjustment Transfers for Merged Market Risk Pool (XLSX)
    • Appendix C to Updated 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - HHS Operated Risk Adjustment Program State-Specific Data for 2019 (XLSX)
    • Appendix D to Updated 2018 Benefit Year Risk Adjustment Data Validation Adjustment Report - Table 4: Issuer-Specific Comparison of Original and Reissued 2018 Benefit Year HHS-RADV Adjustments to 2019 Benefit Year Risk Adjustment Transfers Amounts (XLSX)
    • Appendix A: 2019 Benefit Year HHS-RADV National Program Benchmarks (XLSX)
    • Appendix B: State Market Risk Pools with 2020 Risk Adjustment Transfers Impacted By 2019 Benefit (XLSX)
      Year HHS-RADV Results
    • Appendix B Supplement: Estimated 2020 Benefit Year Risk Adjustment Market Weighted Average Risk Score Adjustment Factors from 2019 Benefit Year HHS-RADV Results (PDF) (added as of April 7, 2022)
    • Appendix C: State Market Risk Pools with 2019 Risk Adjustment Transfers Impacted By 2019 Benefit
      Year HHS-RADV Results (Exiting Issuers) - "Not Applicable for 2019 Benefit Year"
    • Appendix D: 2019 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
    • Appendix A: Interim 2021 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX)
    • Appendix B: Interim 2021 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix A to 2021 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
    • Appendix B to 2021 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix C to 2021 Benefit Year Risk Adjustment Summary Report – Table 4: Issuer-Specific Information for Non-Merged Market Issuers (XLSX) (Revised July 19, 2022)
    • Appendix D to 2021 Benefit Year Risk Adjustment Summary Report – Table 5: Issuer-Specific Information for Merged Market Issuers (XLSX)
    • Appendix E to 2021 Benefit Year Risk Adjustment Summary Report – Table 8: Default Risk Adjustment Charge (XLSX)
    • Appendix F to 2021 Benefit Year Risk Adjustment Summary Report – Table 9: Default Risk Adjustment Charge Allocation (XLSX)
    • Appendix A: National Program Benchmarks – 2020 Benefit Year HHS-RADV Compared to Reissued 2019 Benefit Year HHS-RADV (XLSX)
    • Appendix B: 2020 Benefit Year RA State Market Risk Pool Weighted Average Error Rate from the Reissued 2019 Benefit Year HHS-RADV Results and the 2020 Benefit Year HHS-RADV Result (XLSX)
    • Appendix C: 2020 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
    • Appendix D: 2019 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
    • Appendix A to Summary Report of 2019 and 2020 Benefit Year HHS-RADV Adjustments to Risk Adjustment Transfers - Table 2: Issuer-Specific 2019 and 2020 HHS-RADV Adjustment to 2020 Risk Adjustment Transfer for Non-Merged Market Risk Pools (XLSX) (XLSX)
    • Appendix B to Summary Report of 2019 and 2020 Benefit Year HHS-RADV Adjustments to Risk Adjustment Transfers - Table 3: Issuer - Specific 2019 and 2020 HHS-RADV Adjustments to 2020 Risk Adjustment Transfers for Merged Market Risk Pool (XLSX)
    • Appendix C to Summary Report of 2019 and 2020 Benefit Year HHS-RADV Adjustments to Risk Adjustment Transfers - Table 5: 2019 Benefit Year HHS Default Data Validation Charge (XLSX) (XLSX)
    • Appendix D to Summary Report 2019 and 2020 Benefit Year HHS-RADV Adjustments to Risk Adjustment Transfers - Table 6: 2019 Benefit Year HHS Default Data Validation Charge Allocation (XLSX)
    • Appendix E to Summary Report 2019 and 2020 Benefit Year HHS-RADV Adjustments to Risk Adjustment Transfers - HHA Operated Risk Adjustment Program State-Specific Data for 2020 (XLSX) (XLSX)
    • Appendix A: Interim 2022 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX)
    • Appendix B: Interim 2022 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix A: National Program Benchmarks - 2021 Benefit Year HHS-RADV (XLSX)
    • Appendix B: 2021 Benefit Year RA State Market Risk Pool Weighted Average Error Rate (XLSX)
    • Appendix C: 2021 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
    • Appendix A to 2022 Benefit Year Risk Adjustment Summary Report - HHS Risk Adjustment Program State-Specific Data (XLSX)
    • Appendix B to 2022 Benefit Year Risk Adjustment Summary Report - HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix C to 2022 Benefit Year Risk Adjustment Summary Report - Table 4: Issuer-Specific Information for Non-Merged Market Issuers (XLSX)
    • Appendix D to 2022 Benefit Year Risk Adjustment Summary Report - Table 5: Issuer-Specific Information for Merged Market Issuers (XLSX)
    • Appendix E to 2022 Benefit Year Risk Adjustment Summary Report - Table 8: Default Risk Adjustment Charge (XLSX)
    • Appendix F to 2022 Benefit Year Risk Adjustment Summary Report - Table 9: Default Risk Adjustment Charge Allocation (XLSX)
    • Appendix A to Summary Report of 2021 Benefit Year HHS-RADV Adjustments to Risk Adjustment State Transfers - Table 2: Issuer-Specific 2021 HHS-RADV Adjustments to 2021 Risk Adjustment State Transfer for Non-Merged Market States (XLSX)
    • Appendix B to Summary Report of 2021 Benefit Year HHS-RADV Adjustments to Risk Adjustments State Transfers - Table 3: Issuer-Specific 2021 HHS-RADV Adjustments to 2021 Risk Adjustment State Transfers for Merged Market States (XLSX)
    • Appendix C to Summary Report of 2021 Benefit Year HHS-RADV Adjustments to Risk Adjustment State Transfer: HHS-Operated Risk Adjustment Program State-Specific Data (XLSX)
    • Appendix A: Interim 2023 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX)
    • Appendix B: Interim 2023 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix A: National Program Benchmarks – 2022 Benefit Year HHS-RADV (XLSX)
    • Appendix B: 2022 Benefit Year RA State Market Risk Pool Weighted Average HHS-RADV Error Rates (XLSX)
    • Appendix C: 2022 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
    • Appendix A to Summary Report of 2022 Benefit Year HHS-RADV Adjustments to Risk Adjustment State Transfers - Table 2: Issuer-Specific 2022 HHS-RADV Adjustments to 2022 Risk Adjustment State Transfers for Non-Merged Market States (XLSX)
    • Appendix B to Summary Report of 2022 Benefit Year HHS-RADV Adjustments to Risk Adjustment State Transfers - Table 3: Issuer-Specific 2022 HHS-RADV Adjustments to 2022 Risk Adjustment State Transfers for Merged Market States (XLSX)
    • Appendix C to Summary Report of 2022 Benefit Year HHS-RADV Adjustments to Risk Adjustment State Transfers: HHS-Operated Risk Adjustment Program State-Specific Data (XLSX)
    • Appendix A to 2023 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Program State-Specific Data (XLSX)
    • Appendix B to 2023 Benefit Year Risk Adjustment Summary Report – HHS Risk Adjustment Geographic Cost Factor (GCF) (XLSX)
    • Appendix C to 2023 Benefit Year Risk Adjustment Summary Report – Table 4: Issuer-Specific Information for Non-Merged Market Issuers (XLSX)
    • Appendix D to 2023 Benefit Year Risk Adjustment Summary Report – Table 5: Issuer-Specific Information for Merged Market Issuers (XLSX)
    • Appendix E to 2023 Benefit Year Risk Adjustment Summary Report – Table 8: Default Risk Adjustment Charge (XLSX)
    • Appendix F to 2023 Benefit Year Risk Adjustment Summary Report – Table 9: Default Risk Adjustment Charge Allocation (XLSX)