States ranked by total MLR rebates in 2024

Becker's Healthcare December 31, 2025
Jakob Emerson

Alabama insurers issued the highest amount of medical loss ratio rebates to consumers in 2024, according to KFF.

Under the ACA, if an insurer in the individual market spends less than 80% of premium revenues on clinical services and quality improvement, it is required to provide a rebate to customers, based on a 3-year average. The ranking data was obtained from CMS.

States ranked by total MLR rebates in 2024:

1. Alabama: $181,950,179
2. Missouri: $156,356,470
3. South Carolina: $138,197,855
4. Louisiana: $130,147,819
5. Texas: $126,713,875
6. North Carolina: $99,695,252
7. Florida: $91,197,982
8. Oklahoma: $88,703,731
9. Ohio: $78,900,931
10. Massachusetts: $75,616,534
...

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