Description: This article provides an overview of critical illness insurance: history, product description, and the three primary ways to offer critical illness coverage in the United States. This article also contains an illustration of an issue age premium rate calculation, as well as product features and rating applications specific to the various types of critical illness coverage.

Description: "This video by Danika Turner is an introduction to Medicare Advantage revenue, specifically focusing on how Part C revenue works for individual Medicare Advantage plans. It explains how health plans participating in the Medicare Advantage program are paid by the Centers for Medicare and Medicaid Services (CMS), including the impact of Star ratings, risk adjustment, and county-level CMS benchmark rates on revenue. The session aims to simplify the main variables of the revenue calculation and uses conceptual examples for individual MA plans, excluding certain populations like Employer Group Waiver Plans and members with End-Stage Renal Disease or in hospice. The video also covers the basics of Medicare-covered services, mandatory and optional supplemental benefits, and the calculation steps for determining CMS Part C revenue per member per month.

Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: This is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: During the past few years, performance, cost, and risk trends for Medigap products have undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others might increase them. Part 1 of this Issue Brief article discusses current changing trends and considerations around about how they are impacting Medigap.

Description: In this session we will discuss the impact of regulation changes that will allow members with End State Renal Disease (ESRD) to sign up for Medicare Advantage in 2021 for the first time. We will delve into the current basics of how ESRD works, the characteristics of the population that is currently on original medicare today, and a comprehensive look at what plan sponsors should be thinking about going into 2021.

Description: The big event of 2023 is the launch of multiple Humira biosimilars, which began in January with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing the specialty drug marketplace in the United States. The expectation of the full impact of this big event is very hopeful, but there is still uncertainty several months after its beginning. Humira is the highest-selling drug in the world and has been since 2013 (Figure 1)—except for when COVID-19 projects temporarily surpassed it. The world is eagerly awaiting the launch of multiple biosimilar drugs to compete with Humira and hopefully bring more competitive pricing to the benefit of payers and patients everywhere.

Description: This is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits. This is Part 2; Part 1 was featured in Health Watch's Sept 2024 issue.