Supplemental claims increased risk scores by over 5% in the 2023 ACA individual market. A 5% increase can translate to approximately $15-$25 PMPM or $1.5 to $2.5 million dollars for a 10,000-member, 100,000-member month population.
This 5% represents a continued year-over-year increase in supplemental claims impact. Health plans should understand their current risk score gaps, operations, and opportunity for improvements to remain competitive and financially stable in the zero-sum ACA marketplace.
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