John Bertko is currently an independent actuarial consultant working as the Chief Actuary with Covered California (California’s Insurance Marketplace) and performs contract work for CMS on specific projects related to the ACA. He was the Director of Special Initiatives and Pricing in the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services (CMS), retiring from this position as of January 31, 2014. He served on the Massachusetts Connector Board from October 2014 to March 2015. He formerly was a Senior Fellow at the LMI Center for Health Reform, Adjunct Staff at RAND, a Visiting Scholar at the Brookings Institution, a Visiting Scholar at the Center for Health Policy at Stanford and the retired Chief Actuary of Humana Inc., where he managed the corporate actuarial group and directed work by actuarial staff for Humana’s major business units, including developing Part D, Medicare Advantage and consumer-driven health care products. He has extensive experience with risk adjustment and has served in several public policy advisory roles. He serves on the panel of health advisors for the Congressional Budget Office and completed a 6-year term on the Medicare Payment Advisory Commission (MedPAC). He served the American Academy of Actuaries as a board member from 1994 to 1996 and as vice president for the health practice council from 1995 to 1996. He is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. He has a B.S. in mathematics from Case Western Reserve University.


Recent Posts by John Bertko

Amid ACA Uncertainty, Covered California’s Risk Profile Remains Stable

One of the constant concerns about the ACA and the status of the exchanges involves the average health status of enrollees in these state Marketplaces. Results reveal encouraging news, for amid talk of death spirals, it suggests Covered California continues to attract a healthy mix of enrollees.

What Risk Adjustment Does — The Perspective Of A Health Insurance Actuary Who Relies On It

Under the ACA, insurers offering new policies in the individual market must cover anyone who can pay. However, there are still ways for insurers to avoid the sickest people. What could Congress do to minimize avoidance of people more likely to use care? One good answer: risk adjustment.

Health Risk Continues To Improve In Covered California

The health risk scores of enrollees for individual plans in the California exchange have stabilized in the second year (regressed to the mean), with risk being more evenly distributed across all of the plans, and the overall risk score statewide for enrollees with chronic conditions has decreased.

Credit Scores: Juicing Up The Mandate

Americans carry large amounts of consumer debt.  They are directly affected by credit scores, because the scores affect the interest rates they pay, and the amount of credit they are offered.  One late payment of a bill:  a 60- to 110-point score reduction.  Simply hitting the limit on a credit...