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Interactive Analysis: 2025 ACA Risk Adjustment Transfer Payment Results

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JEAN BECKER

DATA ANALYST

As a data analyst at Pareto, Becker contributes to the design and implementation of advanced features that strengthen our core solutions and increase market impact. With a strong foundation in data and a mindset for growth, Becker brings both technical skill and a collaborative approach to every project—enhancing the depth, usability, and value of our analytics.

RORY NEBEL

ASSOCIATE, CLIENT ADVISORY

As a member of the Client Advisory team, Rory supports the delivery of Pareto’s solutions and provides strategic guidance to healthcare clients. With a focus on execution and relationship-building, Rory helps plans understand and apply insights that drive performance and long-term value.

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On June 30th, 2026, 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 2025 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:

  1. How are state average metrics trending year-over-year?
  2. How do premium changes compare across different markets (by state)?
  3. How are high-cost risk pool payments correlated with transfer payments?
  4. How are transfer payments as a percent of premium changing in the Individual and Small Group market?
  5. What types of plans are capturing transfer payments (e.g., Nationals, Blues Plans, Provider-Sponsored)?
  6. 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 2025 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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