Nicholas Johnson
FSA, MAAA
Principal & Consulting Actuary
Seattle, WA, US
Nick Johnson is a principal and consulting actuary specializing in healthcare in Milliman’s Seattle office. He joined the firm in 2009.
Experience
Nick’s primary expertise is in helping clients understand the financial implications of trends and changes in the healthcare delivery system, particularly in Medicare and dual-eligible populations.
He has worked with a broad range of clients, including health plans, integrated delivery systems, provider groups, reinsurers, and the Veterans Health Administration. He has significant experience in Medicare Advantage, Medicare Part D, Medicaid, commercial, and ACA markets.
Nick’s primary focus areas, including examples of recent analyses, include:
Medicare Advantage / Part D
- Bid development and certification
- Product development and feasibility analysis
- Risk score monitoring, forecasting, and optimization
- Risk-sharing contract support for health plans and providers
Managed long-term services and supports (MLTSS)
- Medicaid MLTSS RFP response
- Nursing home to HCBS transition monitoring
- Forecasting and analysis of programmatic changes
- PACE capitation rate setting
Reinsurance and stop loss
- Review of quota share opportunities
- Stop loss reserve estimation
- Milliman Excess Product Suite tool development
Professional Designations
- Fellow, Society of Actuaries
- Member, American Academy of Actuaries
Education
- BA, Mathematics, Augustana College
- MS, Applied Statistics, Portland State University
Publications
Read their latest work
Article
CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers
09 March 2026 - by Ann Conmy, Annie P Hallum, Nicholas Johnson, Charlie Mills, Chris Smith
We explore what the Medicare-Medicaid integration opportunity could mean for states as the CMS’s new ACO LEAD model details are released.
Article
Key insights into 2025 Medicare Advantage D-SNP landscape
28 March 2025 - by Nicholas Johnson, Annie P Hallum, Nick Gipe, Logan Blank
The 2025 Medicare Advantage D-SNP landscape: We give some key insights amid the market’s slower growth and recent regulatory changes.
Article
CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?
08 July 2024 - by Jessica Bertolo, Annie P Hallum, Nicholas Johnson
We outline the key policy and financial impacts of the 2025 Medicare rules for Medicaid agencies.
Article
Navigating the Intersection of Medicare and Medicaid – Dual-Eligible Beneficiaries
12 April 2024 - by Zachary Fohl, Dean Johnson, Nick Gipe, Annie P Hallum, Jessica Bertolo, Marlene Howard, Nicholas Johnson
We provide an overview of the complexities surrounding the intersection of Medicare and Medicaid, and explore opportunities to better serve dual-eligible beneficiaries.
Article
Key insights into 2024 Medicare Advantage D-SNP landscape
05 March 2024 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
As the Medicare Advantage D-SNP market evolves, MAOs, states, and other stakeholders will need to understand the financial and competitive implications.
Video
Medicare Advantage, Part D, and duals regulatory changes
21 February 2024 - by Nicholas Johnson, Jason Karcher, Sam Shellabarger, Ryan Swenson
A deep dive into the policies influencing Medicare Advantage, Part D, and the dual-eligible market.
Article
Key insights into 2023 Medicare Advantage D-SNP landscape
07 April 2023 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
We present six key insights into the changing landscape for Medicare Advantage’s dual-eligible special needs plans (D-SNPs) for calendar year 2023.
Video
Webinar: D-SNPs: Beyond the Bid
14 September 2022 - by Barbara Culley, Nicholas Johnson, Michelle N. Angeloni, Penny Edlund
Join us as our consultant team provides an overview of the Dual Eligible Special Needs Plan (D-SNP) landscape, operational considerations, model of care requirements, and policy changes impacting the implementation and operation of a D-SNP.
Article
Key insights into 2022 Medicare Advantage D-SNP landscape
01 February 2022 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
We offer key insight on the growing market of dual eligible special needs plans, which enroll beneficiaries who are both eligible for Medicare and Medicaid.
Article
Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries
08 February 2021 - by Nicholas Johnson, Sam Shellabarger, Annie P Hallum
Centers for Medicare and Medicaid introduced the Direct Contracting entity for individuals dually eligible for Medicaid and Medicare in December 2020.