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.
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Kaiser Analysis: Estimated Health Insurance Rebates Under the Health Reform Law Total $1.3 Billion in 2012
NEWS RELEASE April 26, 2012 Rebates Expected to Vary Significantly by State MENLO PARK, Calif. – Consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the Affordable Care Act…
Private insurance companies expect to pay a record of $2.7 billion in rebates to consumers in 2020 due to excessive premiums in recent years – nearly double last year’s then-record total.
Three 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.
This poll, conducted as the GOP prepares for its national convention, finds that the Affordable Care Act is not the top health care priority among Republicans. While jobs are still the number one issue for Republicans, when asked about the health care issues that will impact their vote this fall,…
This data note looks at trends in insurer financial performance in the individual market, as the Affordable Care Act (ACA) marketplaces were established, finding that the market showed signs of stabilizing in 2016.
We estimate insurers will be issuing a total of at least $1.3 billion in MLR rebates across all markets – exceeding the previous record high of $1.1 billion in 2012, due in part to the record profits insurers made in 2018. The amount varies by market, with insurers reporting at least $743 million in the individual market, $250 million in the small group market, and $284 million in the large group market.
More than half of all Medicaid beneficiaries now receive their services in risk-based managed care plans, and states’ use of managed care is expanding. States operate their own Medicaid managed care programs within federal rules and requirements. The federal regulations were last updated in 2002 and a new proposed rule is expected in Spring 2015. This brief identifies key issues in the regulation and discusses how CMS might address them.
This report examines nursing facility expenditures to assess relative spending increases in areas such as nursing services, administrative costs, and profits. Using California as a case study, it explores reimbursement by cost category and a standard medical loss ratio (MLR) as potential policy options to improve nursing facility financial accountability and care quality.
In a close vote, the National Association of Insurance Commissioners (NAIC) recently adopted a resolution urging Congress and the Department of Health and Human Services (HHS) to exempt insurance broker and agent compensation from medical loss ratio (MLR) requirements or otherwise adjust the requirements to ease their effect. HHS last…