Evensun Health Store
Evensun Health Store
We're providing the most up to date intelligence from publicly available datasets and our experience as ACA marketplace CFOs. None of this information is garnered from materially nonpublic information but our information and understanding of how to use publicly available data to understand what is happening with public firms makes us unique as a firm. Your compliance departments can check out our page here: Investor Compliance and Disclosures
Purchasing the toolkit gets you immediate access to our analysis and summary file for the 2026 Open Enrollment period based on public use files from CMS released on October 28, 2025, which is described in detail here. In addition, it gives you access to the following material as information is released.
Late Oct → Jan 28
Primary CMS drops
Rate PUFs (FFE) and CMS plan data files (Oct/Nov refreshes)
URR artifacts (URRT + narratives; late Oct into Nov)
Ongoing CMS landscape updates through OE
Medical Loss Ratio PUFs
What we deliver
Excel Toolkit: pre and post-subsidy net premiums by county/rating area; switching matrix (Bronze/Silver/Gold).
Pricing & positioning: issuer price rank, $0-net premium availability, crosswalk highlights.
URR decomposition: morbidity trend, utilization, admin, Rx, contracting—filed vs. final.
OE nowcasts: semi-monthly read-through on plan/metal momentum (qualitative + historical elasticities) as OEP snapshots from CMS are released
Investor signals
Near-term membership share leaders/laggards heading into Jan 1.
Pricing discipline vs. peers; risk of adverse selection by tier.
Read-through for Q1 membership and CAC efficiency.
Jan 29 → Apr 28
Primary CMS drops
Open Enrollment Period (OEP) PUFs (March): final Jan-1 selections.
Interim Risk Adjustment (March): statewide risk score direction.
Machine-Readable (provider/formulary) file checks for contracting shifts.
What we deliver
OEP scoreboard: who won/lost on selections; issuer depth by county & metal.
Interim RA note: states with rising risk and areas where States may have Risk Adjustment Receivable shortfalls (like Bright and Friday in 2023); issuers likely over/under Note-24 accrual assumptions.
Network changebook: detectable provider adds/drops; formulary shifts tied to price moves.
Investor signals
Confirmation of membership momentum into Q1.
Early RA headwind/tailwind setup for the benefit year.
Contracting events that explain price or share outcomes.
Apr 29 → Jul 28
Primary CMS drops
Effectuated Enrollment (May, as-of March): paid-member reality vs. selections.
Final Individual Market RA Report (~late June): issuer/state transfers.
HHS-RADV results (typically summer windows begin; may slip into July).
First SERFF preliminary rate filings (July start for many states).
What we deliver
Attrition analysis: selections → effectuated falloff; issuer retention curves.
RA vs. accruals bridge: deltas to Note-24; EPS sensitivity heat map.
Pre-earnings brief: quantified RA and RADV surprises by issuer.
Early 2027 rate tape: preliminary weighted-average increases, margin recapture vs. trend.
Investor signals
Quality of OEP and revenue run-rate into Q2.
P&L impacts before earnings from RA/RADV deltas.
Direction of the next rate cycle and competitive stance.
Jul 29 → Sep 29
Primary CMS drops
Continued SERFF preliminary/rate updates (wider state coverage).
Plan-Year issuer/crosswalk refreshes (Aug).
EDGE LDS (≈ two-year lag; usually Sep).
MLR public files (late Sep cadence).
Ongoing MR provider/formulary updates.
What we deliver
Crosswalk migration map: forced moves, silver-loading dynamics, churn risk.
Code-level performance (EDGE): condition-category drift; morbidity driver validation.
MLR tracker: three-year rolling MLR, rebate probability model.
Issuer tear sheets refreshed with rate outlook + rebate/RA context.
Investor signals
Pre-OEP churn and metal-mix risk; product rationalization tells.
Validation/diagnosis of risk trends at a code level.
Rebate overhang/relief and capital planning implications heading into year-end.