View the Latest: Medical Loss Ratio (MLR)
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A Look at Medicaid Enrollment and Finances of the Five Largest Medicaid Managed Care Plans
Issue BriefThis brief examines enrollment and financial data through the end of September 2024 from quarterly company earnings reports and calls, financial filings, and other company materials as well as from national administrative data.
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Health Insurer Financial Performance in 2023
Issue BriefUsing health insurer financial data for 2023, we find that in 2023, per enrollee gross margins were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual insurance market. Across most markets, gross margins have been relatively stable in recent years.
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2024 Medical Loss Ratio Rebates
Issue BriefInsurers estimate they will pay $1.1 billion in Medical Loss Ratio (MLR) rebates in 2024 to select individuals and employers that purchase their health coverage, according to a KFF analysis of preliminary data reported to state regulators. The estimated rebate for 2024 is larger than rebates issued in most prior years. Nearly $12 billion in rebates have been issued since 2012.
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Private Insurers Expect to Pay $1.1 Billion in Rebates This Year for Setting Premiums Too High Relative to Medical Costs
News ReleasePrivate insurance companies are expecting to pay out about $1.1 billion in rebates this fall under an Affordable Care Act (ACA) provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three years.
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Strategies to Manage Unwinding Uncertainty for Medicaid Managed Care Plans: Medical Loss Ratios, Risk Corridors, and Rate Amendments
Issue BriefThis brief provides a high-level snapshot of states with minimum medical loss ratio (MLR) and remittance requirements and risk corridors in place as of July 1, 2022 that may provide financial protection and limits on financial risk for states and plans as the unwinding unfolds.
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Private Insurers Expect to Pay $1 Billion in Rebates to Consumers This Year for Setting Premiums Too High Relative to Medical Costs
News ReleasePrivate insurance companies are expecting to pay out $1 billion in rebates to consumers this fall under an Affordable Care Act provision that requires insurers to spend the bulk of customers’ premium payments on care, a new KFF analysis finds. Rebates are based on insurers’ experiences over the previous three years.
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Individual Insurance Market Performance in 2019
Issue BriefNew data from 2019 suggest that insurers in the individual market remain profitable, even with average premiums falling for the first time since the ACA was implemented. These data indicate that the individual market appears to be stable in 2019, despite the repeal of the individual mandate penalty and the proliferation of loosely-regulated short-term insurance plans.
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As Policymakers Debate Medicare-for-All, Analysis Finds the Medicare Advantage, Individual and Group Health Insurance Markets Appear to Be Profitable, Especially Medicare Advantage
News ReleaseThree key private health insurance markets -- Medicare Advantage, the individual market and the fully-insured group market -- appear to be financially healthy and attractive to insurers, according to a new KFF analysis. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market, the analysis finds.
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Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets
Issue BriefThree key private health insurance markets -- Medicare Advantage, the individual market and the fully-insured group market -- appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.