Total risk adjustment payments in individual and small group insurance plans increased modestly in 2024, according to new data from CMS.
The agency published its annual summary report of risk adjustment payments June 18. The risk adjustment program is designed to evenly spread financial risk between plans enrolling higher-risk individuals in each state market. According to CMS, the program is “working as intended.”
Here are five things to know:
- A total of 592 plans participated in the risk adjustment program in 2024, a decrease from 605 in 2023.
- Risk adjustment transfers as a share of premiums declined compared to 2023. In 2024, these payments accounted for about 8.9% of total premiums, down from 10.3% in 2023.
- The proportion of enrollees with at least one hierarchical condition category — indicating higher health risk — rose slightly, from 21.8% in 2023 to 22% in 2024.
- Premiums increased slightly in the individual market, rising 0.3% from 2023 to 2024. In the small group market, premiums rose 6.1%.
- Enrollment in individual plans jumped 26.5% from 2023 to 2024.
Read the full report here.
