The federal government risk adjustment program is a risk sharing cooperative in the individual health insurance market place designed to transfer funds from profitable insurance companies to less profitable ones.
Can you imagine if this were true for group health insurance policies? A risk cooperative made up of millions of insured members?
Lets imagine for example your group plan is getting a double digit rate increase because your claims are running hot. If there was a federal risk adjustment program in place for traditional group health plans (there isn’t) your risk would be subsidized by profitable plans through risk transfer assessments. No need for stop loss insurance. Never a laser.
ICHRA plans benefit by the government mandated risk adjustment program. Traditional group health plans don’t because they can’t.
Proposed 2026 Payment Notice: Risk Adjustment | Health Affairs
