The Department of Health and Human Services finalized an update to the risk adjustment model coefficients used to determine the payment transfer amounts for the 2016 ACA market. The impact of these changes depends on each carrier’s mix of enrollees. But there are several consistent themes when comparing the updated coefficients with the current ones. For example, carriers that enroll a disproportionate share relative to the market of sicker or higher risk individuals are likely to receive higher risk transfer payments. And carriers that enroll a disproportionate share of healthier individuals are likely to receive lower transfer payments or will have to pay higher amounts to other carriers.
