ACA Risk Adjustment Transfers — 2025 Benefit Year

The Affordable Care Act's risk adjustment program is a zero-sum transfer between insurance companies inside each state's market. Every year, CMS calculates how sick each carrier's members were compared to the state average. Carriers whose members were healthier than average write a check; carriers whose members were sicker than average cash it.

The goal is to remove the incentive for insurers to cherry-pick healthy people, and to protect carriers who happen to enroll people with expensive conditions. Consumers don't pay these transfers directly — they show up between insurance companies — but they influence how carriers price plans in future years.

• Individual (Non-Catastrophic) — the standard on- and off-exchange ACA market.
• Catastrophic — bare-bones plans for people under 30 or with hardship exemptions.
• Small Group — employer-sponsored plans for businesses under 50 (or 100) employees.
• High-Cost Risk Pool (HCRP) — reinsurance-style payments to carriers who had members with claims over $1,000,000.

• Data covers 47 state markets from CMS Table 6 (non-merged markets). Maine and Massachusetts operate merged individual+small-group markets and are reported separately by CMS.
• Some carriers appear with $0 or "—" in specific columns — that means they didn't participate in that market risk pool in the state.
• The High-Cost Risk Pool (HCRP) is funded by a small per-member charge and reimburses 60% of claims above $1,000,000 per enrollee.
• These are 2025 benefit-year results, released by CMS in June 2026. Actual carrier premium and enrollment decisions for 2027 plan year already reflect prior-year risk adjustment history.