Agency Jerdon Johnston Agency Jerdon Johnston

CMS (Centers for Medicare & Medicaid Services)

A federal agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs including Medicare, Medicaid, and CHIP, as well as oversight of the ACA Marketplace.

A federal agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs including Medicare, Medicaid, and CHIP, as well as oversight of the ACA Marketplace.

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Payment Model Jerdon Johnston Payment Model Jerdon Johnston

Risk Adjustment

A process used by health insurance companies to adjust payments based on the health status of their enrollees. It ensures that plans enrolling higher-risk individuals (such as those with chronic conditions) are compensated to maintain financial stability. Medicare Advantage and ACA Marketplace plans use risk adjustment.

A process used by health insurance companies to adjust payments based on the health status of their enrollees. It ensures that plans enrolling higher-risk individuals (such as those with chronic conditions) are compensated to maintain financial stability. Medicare Advantage and ACA Marketplace plans use risk adjustment.

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