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Text of CMS Benefit Year 2018 Risk Adjustment Summary Report (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
July 1, 2019
33 pages. "[F]or the 2018 benefit year: [1] Risk adjustment transfers as a percent of premiums slightly decreased compared to the 2017 benefit year.... [2] Amount of paid claims remains strongly correlated with risk adjustment transfers ... [3] Predictability between interim and final risk scores remained stable between the 2017 and 2018 benefit years ... [4] Risk scores remained similar between 2017 and 2018.... [5] Average premiums in the individual non-catastrophic risk pool increased significantly in 2018 ... [6] The high-cost risk pool helped ensure that risk adjustment transfers better reflect the average actuarial risk, while also providing protection to issuers with exceptionally high-cost enrollees."

Data available in XLSX format:

  • Appendix A: HHS Risk Adjustment Program State-Specific Data
  • Appendix B: HHS Risk Adjustment Geographic Cost Factor (GCF)
  • Appendix C: Issuer-Specific Information for Non-Merged Market Issuers
  • Appendix D: Issuer-Specific Information for Merged Market Issuers
  • Appendix E: Default Risk Adjustment Charge
  • Appendix F: Default Risk Adjustment Charge Allocation

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