CMS: 2015 Marketplace data suggests improving risk pool

Monthly medical costs per enrollee in the Health Insurance Marketplaces fell by 0.1% between 2014 and 2015, with larger declines in states with higher-than-average enrollment growth, suggesting year-over-year improvement in the individual risk pool, according to a report released today by the Centers for Medicare & Medicaid Services. After adjusting for comparability, per-member-per-month paid claims fell by 0.1% between 2014 and 2015, compared with an increase of 3%-4% in the broader health insurance market, the agency said. In the 10 states with the highest 2015 growth in individual market member months, claims costs fell by an average 5%. The 2015 claims data, which exclude grandfathered and transitional plans, predate CMS’s changes to the Marketplace special enrollment periods to strengthen the risk pool. The agency also plans to strengthen outreach to young adults for the next open enrollment period. “With these new actions in 2016, as well as the expiration of remaining transitional policies by the end of 2017, we expect that the Marketplace risk pool will continue to grow and improve going forward,” CMS said.