This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and businesses.
President Donald Trump and Republicans in Congress pursued several major efforts to repeal and replace the Affordable Care Act (ACA) but were unable to get a bill through the U.S. Senate in 2017. In 2018, Congress did pass a tax bill that eliminated the ACA’s tax penalty for not obtaining health coverage beginning in 2019. The Trump Administration’s actions and decisions also have affected the ACA marketplaces and will continue to reshape how Americans get health insurance into 2019 and beyond.
For information about ACA Marketplace Open Enrollment, including fact sheets and 300+ FAQs, visit our collection of resources on Understanding Health Insurance.
Featured Affordable Care Act Resources
This list of more than 300 Frequently Asked Questions (FAQs) covers the Affordable Care Act’s health insurance Marketplace (aka exchange), individual mandate, open enrollment, premiums and more. It provides answers to questions about specific groups, such as young adults, smokers, the uninsured, and non-traditional households.
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Related Affordable Care Act Resources
- 6 Charts About Public Opinion On The Affordable Care Act
- What Does the Outcome of the Midterm Elections Mean for Medicaid Expansion?
- How ACA Marketplace Premiums Are Changing by County in 2020
- Insurer Participation on ACA Marketplaces, 2014-2020
- KFF Health Tracking Poll – November 2018: Priorities for New Congress and the Future of the ACA and Medicaid Expansion
- How Repeal of the Individual Mandate and Expansion of Loosely Regulated Plans are Affecting 2019 Premiums
- How Many of the Uninsured Can Purchase a Marketplace Plan for Free?
- Why Do Short-Term Health Insurance Plans Have Lower Premiums Than Plans That Comply with the ACA?
On December 14, 2018, a federal trial court judge ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and that the entire law should be struck down as a result. This brief considers the complex and far-reaching impact were the entire law ultimately held to be invalid.
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The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients…
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Affordable Care Act Provisions Relating to the Care of Dually Eligible Medicare and Medicaid Beneficiaries
This issue brief identifies the major provisions in the Patient Protection and Affordable Care Act (ACA) that are designed to improve care and streamline service delivery for dual eligibles, the millions of low-income seniors and younger persons with disabilities who are enrolled in both the Medicaid and Medicare programs. Dual…