Individual Insurance Market Performance in 2019
The loss ratios shown in this issue brief differ from the definition of MLR in the ACA, which makes some adjustments for quality improvement and taxes, and do not account for reinsurance, risk corridors, or risk adjustment payments. Reinsurance payments, in particular, helped offset some losses insurers would have otherwise experienced. However, the ACA’s reinsurance program was temporary, ending in 2016, so loss ratio calculations excluding reinsurance payments are a good indicator of financial stability going forward.
Average premiums per member per month increased in 2019, even while average unsubsidized premiums for the lowest-cost plans in each metal tier went down, because average premiums per member per month reflect changes in the age and geographic distribution of enrollees, changes in plans selected by enrollees, and changes in subsidy amounts.
Hospital patient days for 2014 are not necessarily representative of the full year because open enrollment was longer that year and a number of exchange enrollees did not begin their coverage until mid-year 2014.