Mark Farrah Associates March 4, 2019

The Medical Loss Ratio (MLR) provision established by the Affordable Care Act (ACA) requires health insurers who fail to spend specified percentages of their premium income on medical and quality care improvement expenses to pay rebates to their customers. The goal of this provision is to curb growth in health care premiums while ensuring that plans adequately cover healthcare expenses. In 2015 and 2016, health plans reimbursed customers $406 million and $446 million, respectively. For 2017, lower MLRs resulting from increased profitability overall, led to $709 million in reimbursements to customers, equating to approximately $119 per benefiting family.

Key Details about the MLR

  • The ACA provision for rebates based upon MLR applies to commercial (risk) insurance lines and does...

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Topics: ACA (Affordable Care Act), CMS, Govt Agencies, Insurance, Payer, Public Exchange
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