Humana Gets at Least $549 Million in Obamacare Risk Payments

Updated on

The U.S. government will pay Humana Inc. at least $549 million to reimburse big insurance claims the company covered under the Affordable Care Act, according to federal data released Tuesday.

The reinsurance payments -- which also went to firms like Aetna Inc. and Anthem Inc. -- are designed to stabilize Obamacare’s nascent insurance markets by helping to cover more expensive claims. Details of those payments and a related program that shifts funds among companies were released Tuesday by the Centers for Medicare & Medicaid Services.

The reinsurance program covers health insurers’ costs when an individual member has particularly high medical bills. The government said the risk-transfer program is “working as intended” by moving extra funds to insurers that had large numbers of patients with HIV/AIDS and other costly conditions.

The programs help “keep premiums stable and encourage insurance companies to compete on quality and price, not who can attract the healthiest enrollees,” Kevin Counihan, who oversees the health insurance marketplaces at CMS, said in a statement.

For 2014, when a patient ran up more than $45,000 in expenses, the U.S. paid the balance of the charges up to $250,000. To fund the program, each insurer paid a $63-per-customer fee.

Total Payout

In total, the U.S. will make about $7.9 billion in reinsurance payments for 2014. The government already has collected about $8.7 billion from insurers this year and expects to take in another $1 billion by Nov. 15. Extra funds can be used for claims in later years.

The U.S. also posted information Tuesday about risk adjustments, which transfers money from insurers with healthier customers to those with sicker ones. The funds come only from other firms, not from taxpayers. The U.S. said transfers amounted to about 10 percent of premiums in the individual marketplace, and to about 21 percent of premiums for catastrophic plans, which provide more limited coverage.

The reinsurance program expires next year, while the risk adjustment program is permanent. Some of the payments are estimated, the government said, and may depend on how much money is ultimately collected from insurers. The risk adjustment data excludes Massachusetts because the state ran its own program.

About 6.3 million people had coverage through the Affordable Care Act’s markets at the end of last year. The law, passed in 2010, stopped insurers from charging sick people more or denying them coverage entirely.

Bloomberg calculated Humana’s total from the U.S. report, which lists each payment to subsidiaries separately. Alex Kepnes, a Humana spokesman, didn’t respond to a request for comment.

Before it's here, it's on the Bloomberg Terminal. LEARN MORE