On June 30th, 2025, the Department of Health and Human Services (HHS) unveiled the highly anticipated Summary Report on Individual and Small Group Market Risk Adjustment Transfers for the 2024 Benefit Year. This report dives into risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market.
In an effort to simplify the data and enhance understanding, Pareto quickly ingested the data provided and developed the interactive analysis below, which includes year-over-year (YOY) comparisons of state average metrics, issuer transfer payments, and high-cost risk pool payments.
Risk Adjustment Transfer Payments
In the dashboard below, you will find a range of interactive buttons at the top that will guide you through the analyses and help you find answers to key questions, including:
- How are state average metrics trending year-over-year?
- How do premium changes compare across different markets (by state)?
- How are high-cost risk pool payments correlated with transfer payments?
- How are transfer payments as a percent of premium changing in the Individual and Small Group market?
- What types of plans are capturing transfer payments (e.g., Nationals, Blues Plans, Provider-Sponsored)?
- How did transfer payments change year-over-year by issuer?
You can filter by year, state/region, metric, and/or risk pool/product (Individual or Small Group market).
Note: State average Plan Liability Risk Score (PLRS) cannot be compared YOY due to adjustments to the CMS-HHS risk adjustment model coefficients. For this reason, Pareto has applied a reduction to all prior year state average PLRS numbers allowing for a more accurate YOY comparison.
Conclusion
The above analysis summarizes HHS data to provide initial insight into the 2024 ACA risk adjustment transfer payment results. We’re dedicated to helping organizations grow, perform, and transform through professional consultancy and award-winning technology solutions.
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Disclaimer: The following BY24 Individual and Small Group Market Risk Adjustment Transfers and Issuer-specific Transfer Payments are based on reports released by CMS on June 30th, 2025. In that report CMS also notes that there was a “late-filed 2024 benefit year risk adjustment discrepancy for 88 HIOS IDs within a company, which potentially impacts 69 state market risk pools across 43 states and the District of Columbia. (…) , CMS will be able to charge and pay issuers accurately (i.e., accounting for this late-filed discrepancy) and will provide updated issuer-level transfer reports in mid-July to issuers in affected state market risk pools that reflect the discrepant issuer’s data and adjusted transfer amounts.” If made public, Pareto will plan on revising the publication to account for the changes when available.