The goal was for these funds to pay 80 percent of a high claimant in excess of $45,000 up to $250,000. In other words, the government had you pay to fund insurance claims that insurance companies normally would have paid, but only for those who purchased individual insurance plans through qualified health plans.
In order to receive reinsurance funds, insurance companies had to offer Obamacare compliant plans. The funds they receive can only be used to fund claims for the people who enrolled in these plans. According to acasignups.net, they estimated that in 2014 there were approximately 16.3 million people (on and off exchange) that had purchased individual qualified health plans.
Even though only 16 million people were in the eligible risk pool, funding for this program came from every single person who has private insurance. In 2014, the fee for each person was $63. Centers for Medicare and Medicaid Services reported that they received a total of $8.7 billion into this program. Based on these figures there were over 138 million people who paid the fee.
In the June 30th CMS summary report, we learned that the government has paid out $7.9 billion to insurance companies. Since reinsurance contributions exceeded the requests for reinsurance payments, CMS decided to increase the coinsurance rate to 100 percent.
For those keeping score allow me to recap:
- Over 138 million people paid a total of $8.7 billion to a reinsurance fund.
- Only 16.3 million people were in the risk pool that this money was set aside to fund claims.
- The money in this fund was supposed to reimburse insurance companies 80 percent of the large claims.
- Instead the government paid the insurance companies 100 percent of the large claims.
- The total paid out was $7.9 billion.