Luis Maldonado

FSA, MAAA

Principal and Consulting Actuary

Berwyn, PA, US

Luis Maldonado is a principal and consulting actuary with the Philadelphia office of Milliman. He joined the firm in 2009.

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Experience

While working at Milliman, Luis has assisted clients from different spectrums of the healthcare industry. This includes work with insurance carriers, health plans, hospitals, IPAs, employer groups, brokers, and PBMs. His projects have involved calculating premiums, reviewing capitation contracts, analyzing benefit changes, and financial projections, among others. He also has a strong knowledge of Medicare Advantage Prescription Drug plans. By having exposure to such a variety of clients, Luis is able to leverage his understanding of all stakeholders and bring significant insight into projects. Current work has focused on Medicare value-based designs, including the Hospice program and other flexible benefit opportunities with a focus on Social Determinants of Health (SDoH) initiatives. Luis also has experience is supporting health insurance trade associations with public policy issues related to Medicaid and Medicare funding.

Prior to joining Milliman, he served as assistant vice president at a leading health insurance carrier. In this position, Luis gained a solid background in claims reserving and valuation, pricing management, product development, group underwriting, statistical data reporting and analysis, and financial forecasting. Prior to that experience, Luis worked as a financial analyst in acquisitions and corporate investments at one of the top 50 largest banks in the United States. His role included active participation in the evaluation and structuring of mergers and acquisitions activity. Luis is also fully bilingual (Spanish and English).

Publications and Presentations

2025 Impact: The inflation reduction act and Medicare Part D Financial Reporting, 2024 SOA Valuation Meeting
Medicare Advantage Hospice Program and End of Life Care. 2022 SOA Impact meeting (virtual).
Co-editor Chapter 9: Government Health Plans in the United States, Group Insurance 8th Edition.
Implications of the COVID-19 pandemic on medical loss ratio for health plans, Milliman Insight.
Key considerations in product design for actuaries for the 2021 MA pricing season, Milliman Insight.
Health Reform Impact for Puerto Rico, Milliman Insight.
Presenter at SOA Latin America Committee first International Program in Actuarial Sciences in May, 2018, Bogota, Colombia.

Professional Designations

Member, American Academy of Actuaries
Fellow, Society of Actuaries

Education

BA, Applied Actuarial Math with minor in Economics, Bryant College, Rhode Island.

Affiliations

Board of Director Member, International Actuarial Association Health Section
Member, SOA Health Cost Trends Steering Committee
Member, SOA Social Determinants of Health POG

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Publications

Read their latest work

Video

Did you VBID your MA bid? We did: A discussion of insights and challenges

11 December 2024 - by Eleanor Hill, Luis Maldonado, Greg Sgrosso, Kelsey Sorum

The 2025 bid season marked the first year of Phase III in the Medicare Advantage VBID program. This phase unveils new requirements and options for MA plans, along with a revamped application process and a competitive bidding rubric.

Video

Walking on eggshells? Looking at the Past, Present and Future of Employer Group Waiver Plans

11 October 2023 - by Greg Sgrosso, Jennifer Carioto, Luis Maldonado, Todd Wanta

Employer Group Waiver Plans (EGWPs) have consistently provided millions of retirees stable medical and prescription drug coverage, but upcoming changes threaten that stability.

Article

High-level impacts of the proposed CMS-HCC risk score model on Puerto Rico Medicare Advantage payments for 2024

08 March 2023 - by Rob Pipich, Luis Maldonado, Stuart D. Rachlin

We provide an overview of the expected high-level impacts of the proposed changes by Medicare plan or population type for MA beneficiaries in the Commonwealth of Puerto Rico.

Article

Implications of the COVID-19 pandemic on medical loss ratio for health plans

20 October 2020 - by Andrew Bochner, Jennifer Carioto, Luis Maldonado

How will COVID-19 affect a health plan’s medical loss ratio requirements in general and what are specific considerations for the commercial, Medicare Advantage, and Medicaid markets in 2020 and going forward?

Article

Key considerations in product design for actuaries for the 2021 MA pricing season

07 April 2020 - by Luis Maldonado, Sylvia Hagin, Brian Regan

Newly available product design options will require actuaries to develop new tools and processes in order to assist Medicare Advantage organizations in bid development.

Article

Medicare Advantage proposed rule could have a profound impact on product development for 2019 and beyond

30 November 2017 - by Luis Maldonado

Article

Health reform impact for Puerto Rico

21 May 2010 - by Luis Maldonado

Healthcare reform will be a boon to Puerto Rico, but it may have some unintended consequences.

Experience

Luis Maldonado

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Experience

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Read their latest work

Did you VBID your MA bid? We did: A discussion of insights and challenges

Walking on eggshells? Looking at the Past, Present and Future of Employer Group Waiver Plans

High-level impacts of the proposed CMS-HCC risk score model on Puerto Rico Medicare Advantage payments for 2024

Implications of the COVID-19 pandemic on medical loss ratio for health plans

Key considerations in product design for actuaries for the 2021 MA pricing season

Medicare Advantage proposed rule could have a profound impact on product development for 2019 and beyond

Health reform impact for Puerto Rico

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Luis Maldonado

Experience

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