The ACA’s Risk Spreading Mechanisms: A Primer on Reinsurance, Risk Corridors and Risk Adjustment

The 2010 Affordable Care Act (ACA) health reform law established state-based health insurance exchanges to provide an individual market for qualified health insurance plans. The state exchanges sell insurance plans to any citizen, regardless of health status. Enrollees who purchase plans through an exchange can receive federal premium subsidies if their household income falls between 100 and 400 percent of the federal poverty level. This primer provides an overview of the ACA’s risk mitigation provisions that apply to individual and/or small group market plans: reinsurance, risk corridors, and risk adjustment.

Primer: Employer Mandate

The Affordable Care Act’s (ACA) Employer Shared Responsibility provision, commonly referred to as the Employer Mandate, requires all employers with more than 50 employees, or 50 Full Time Equivalents (FTEs), to provide health insurance coverage beginning in 2014. Similar to the law’s individual mandate to carry health insurance, noncompliance carries a fine, levied to help offset the cost of providing insurance coverage in the ACA’s state based insurance exchanges.

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