Fierce Healthcare June 6, 2024
Paige Minemyer

Insurers are likely to pay $1.1 billion in Affordable Care Act (ACA) medical loss ratio rebates in 2024, according to a new analysis.

Payers have made a total of $11.8 billion in rebates since 2012, when they became required under the ACA, according to a report from KFF and data compiled by Mark Farrah Associates.

Health plans are required to spend at least 80% of premium income on medical coverage and quality improvements, with the remaining 20% eligible for administrative costs, marketing and profit. The threshold is 85% in large group plans, and, should a plan spend less than those thresholds, it must issue rebates to make up the difference.

Rebates are calculated based on the three previous years, so...

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Topics: ACA (Affordable Care Act), Insurance, Patient / Consumer, Payer, Survey / Study, Trends
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