CMS Claims Cost Data 2014-2016

Principal Investigator(s):  View help for Principal Investigator(s) United States Department of Health and Human Services. Centers for Medicare and Medicaid Services

Version:  View help for Version V1

Name File Type Size Last Modified
2014-to-2015-claims-pmpm-comparison.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 11.9 KB 06/04/2026 01:04:PM
2015-claims-pmpm.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 10.7 KB 06/04/2026 01:04:PM
2016-claims-pmpm.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 11.3 KB 06/04/2026 01:04:PM

Project Citation: 

United States Department of Health and Human Services. Centers for Medicare and Medicaid Services. CMS Claims Cost Data 2014-2016. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2026-06-04. https://doi.org/10.3886/E249269V1

Project Description

Project Title:  View help for Project Title CMS Claims Cost Data 2014-2016
Summary:  View help for Summary Contains three datasets on PMPM insurance claims. One lists the average PMPM claim cost by state for 2015, and another set contains the same for 2016. The third contains modified average costs of claims by state, compared between 2014 and 2015.
Original Distribution URL:  View help for Original Distribution URL https://www.cms.gov/marketplace/resources/data/claims-cost-data-state

Scope of Project

Subject Terms:  View help for Subject Terms health insurance; Medicare; Medicaid
Geographic Coverage:  View help for Geographic Coverage USA
Time Period(s):  View help for Time Period(s) 1/1/2014 – 12/31/2016 (2014-2016)
Collection Date(s):  View help for Collection Date(s) 1/1/2014 – 12/31/2016
Data Type(s):  View help for Data Type(s) administrative records data
Collection Notes:  View help for Collection Notes downloaded from https://www.cms.gov/marketplace/resources/data/claims-cost-data-state on June 4th 2026

Methodology

Sampling:  View help for Sampling Notes: Average claims were calculated by summing total paid claims cost and dividing by the total number of enrollee member months. 
Data Source:  View help for Data Source  All data is from the ACA compliant individual market plans and was collected as part of data submissions to the EDGE server for purposes of the transitional reinsurance program for the 2016 benefit year.  Data collected for purposes of the reinsurance program does not include paid claims that were incurred but not received. 
Unit(s) of Observation:  View help for Unit(s) of Observation State
Geographic Unit:  View help for Geographic Unit State

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Published Versions

V1 [2026-06-04]

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