Nicholas Johnson

FSA, MAAA

Principal & Consulting Actuary

Seattle, WA, US

Nick Johnson is a principal and consulting actuary specializing in healthcare in Milliman’s Seattle office. He joined the firm in 2009.

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Experience

Nick’s primary expertise is in helping clients understand the financial implications of trends and changes in the healthcare delivery system, particularly in Medicare and dual-eligible populations.

He has worked with a broad range of clients, including health plans, integrated delivery systems, provider groups, reinsurers, and the Veterans Health Administration. He has significant experience in Medicare Advantage, Medicare Part D, Medicaid, commercial, and ACA markets.

Nick’s primary focus areas, including examples of recent analyses, include:

Medicare Advantage / Part D

Bid development and certification
Product development and feasibility analysis
Risk score monitoring, forecasting, and optimization
Risk-sharing contract support for health plans and providers

Managed long-term services and supports (MLTSS)

Medicaid MLTSS RFP response
Nursing home to HCBS transition monitoring
Forecasting and analysis of programmatic changes
PACE capitation rate setting

Reinsurance and stop loss

Review of quota share opportunities
Stop loss reserve estimation
Milliman Excess Product Suite tool development

Professional Designations

Fellow, Society of Actuaries
Member, American Academy of Actuaries

Education

BA, Mathematics, Augustana College
MS, Applied Statistics, Portland State University

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Publications

Read their latest work

Article

CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers

09 March 2026 - by Ann Conmy, Annie P Hallum, Nicholas Johnson, Charlie Mills, Chris Smith

We explore what the Medicare-Medicaid integration opportunity could mean for states as the CMS’s new ACO LEAD model details are released.

Article

Key insights into 2025 Medicare Advantage D-SNP landscape

28 March 2025 - by Nicholas Johnson, Annie P Hallum, Nick Gipe, Logan Blank

The 2025 Medicare Advantage D-SNP landscape: We give some key insights amid the market’s slower growth and recent regulatory changes.

Article

CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?

08 July 2024 - by Jessica Bertolo, Annie P Hallum, Nicholas Johnson

We outline the key policy and financial impacts of the 2025 Medicare rules for Medicaid agencies.

Article

Navigating the Intersection of Medicare and Medicaid – Dual-Eligible Beneficiaries

12 April 2024 - by Zachary Fohl, Dean Johnson, Nick Gipe, Annie P Hallum, Jessica Bertolo, Marlene Howard, Nicholas Johnson

We provide an overview of the complexities surrounding the intersection of Medicare and Medicaid, and explore opportunities to better serve dual-eligible beneficiaries.

Article

Key insights into 2024 Medicare Advantage D-SNP landscape

05 March 2024 - by Nicholas Johnson, Annie P Hallum, Nick Gipe

As the Medicare Advantage D-SNP market evolves, MAOs, states, and other stakeholders will need to understand the financial and competitive implications.

Video

Medicare Advantage, Part D, and duals regulatory changes

21 February 2024 - by Nicholas Johnson, Jason Karcher, Sam Shellabarger, Ryan Swenson

A deep dive into the policies influencing Medicare Advantage, Part D, and the dual-eligible market.

Article

Key insights into 2023 Medicare Advantage D-SNP landscape

07 April 2023 - by Nicholas Johnson, Annie P Hallum, Nick Gipe

We present six key insights into the changing landscape for Medicare Advantage’s dual-eligible special needs plans (D-SNPs) for calendar year 2023.

Video

Webinar: D-SNPs: Beyond the Bid

14 September 2022 - by Barbara Culley, Nicholas Johnson, Michelle N. Angeloni, Penny Edlund

Join us as our consultant team provides an overview of the Dual Eligible Special Needs Plan (D-SNP) landscape, operational considerations, model of care requirements, and policy changes impacting the implementation and operation of a D-SNP.

Article

Key insights into 2022 Medicare Advantage D-SNP landscape

01 February 2022 - by Nicholas Johnson, Annie P Hallum, Nick Gipe

We offer key insight on the growing market of dual eligible special needs plans, which enroll beneficiaries who are both eligible for Medicare and Medicaid.

Article

Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries

08 February 2021 - by Nicholas Johnson, Sam Shellabarger, Annie P Hallum

Centers for Medicare and Medicaid introduced the Direct Contracting entity for individuals dually eligible for Medicaid and Medicare in December 2020.

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Read their latest work

Article

CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers

09 March 2026 - by Ann Conmy, Annie P Hallum, Nicholas Johnson, Charlie Mills, Chris Smith

We explore what the Medicare-Medicaid integration opportunity could mean for states as the CMS’s new ACO LEAD model details are released.

Article

Key insights into 2025 Medicare Advantage D-SNP landscape

28 March 2025 - by Nicholas Johnson, Annie P Hallum, Nick Gipe, Logan Blank

The 2025 Medicare Advantage D-SNP landscape: We give some key insights amid the market’s slower growth and recent regulatory changes.

Article

CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?

08 July 2024 - by Jessica Bertolo, Annie P Hallum, Nicholas Johnson

We outline the key policy and financial impacts of the 2025 Medicare rules for Medicaid agencies.

Article

Navigating the Intersection of Medicare and Medicaid – Dual-Eligible Beneficiaries

12 April 2024 - by Zachary Fohl, Dean Johnson, Nick Gipe, Annie P Hallum, Jessica Bertolo, Marlene Howard, Nicholas Johnson

We provide an overview of the complexities surrounding the intersection of Medicare and Medicaid, and explore opportunities to better serve dual-eligible beneficiaries.

Article

Key insights into 2024 Medicare Advantage D-SNP landscape

05 March 2024 - by Nicholas Johnson, Annie P Hallum, Nick Gipe

As the Medicare Advantage D-SNP market evolves, MAOs, states, and other stakeholders will need to understand the financial and competitive implications.

Video

Medicare Advantage, Part D, and duals regulatory changes

21 February 2024 - by Nicholas Johnson, Jason Karcher, Sam Shellabarger, Ryan Swenson

A deep dive into the policies influencing Medicare Advantage, Part D, and the dual-eligible market.

Article

Key insights into 2023 Medicare Advantage D-SNP landscape

07 April 2023 - by Nicholas Johnson, Annie P Hallum, Nick Gipe

We present six key insights into the changing landscape for Medicare Advantage’s dual-eligible special needs plans (D-SNPs) for calendar year 2023.

Video

Webinar: D-SNPs: Beyond the Bid

14 September 2022 - by Barbara Culley, Nicholas Johnson, Michelle N. Angeloni, Penny Edlund

Article

Key insights into 2022 Medicare Advantage D-SNP landscape

01 February 2022 - by Nicholas Johnson, Annie P Hallum, Nick Gipe

We offer key insight on the growing market of dual eligible special needs plans, which enroll beneficiaries who are both eligible for Medicare and Medicaid.

Article

Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries

08 February 2021 - by Nicholas Johnson, Sam Shellabarger, Annie P Hallum

Centers for Medicare and Medicaid introduced the Direct Contracting entity for individuals dually eligible for Medicaid and Medicare in December 2020.

Nicholas Johnson

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Experience

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Read their latest work

CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers

Key insights into 2025 Medicare Advantage D-SNP landscape

CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?

Navigating the Intersection of Medicare and Medicaid – Dual-Eligible Beneficiaries

Key insights into 2024 Medicare Advantage D-SNP landscape

Medicare Advantage, Part D, and duals regulatory changes

Key insights into 2023 Medicare Advantage D-SNP landscape

Webinar: D-SNPs: Beyond the Bid

Key insights into 2022 Medicare Advantage D-SNP landscape

Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries

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CHOOSE A LOCATION AND LANGUAGE

Nicholas Johnson

Experience

Read their latest work

CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers

Key insights into 2025 Medicare Advantage D-SNP landscape

CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?

Navigating the Intersection of Medicare and Medicaid – Dual-Eligible Beneficiaries

Key insights into 2024 Medicare Advantage D-SNP landscape

Medicare Advantage, Part D, and duals regulatory changes

Key insights into 2023 Medicare Advantage D-SNP landscape

Webinar: D-SNPs: Beyond the Bid

Key insights into 2022 Medicare Advantage D-SNP landscape

Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries

CHOOSE A LOCATION AND LANGUAGE