Total Medical Loss Ratio (MLR) Rebates in All Markets for Consumers and Families April 6, 2023 State Indicator
Who Will be the H&R Block and TurboTax for Health Insurance? June 3, 2011 Perspective There’s been quite a bit of focus lately insofar as these issues go, anyway on health insurance agents and brokers (sometimes known in the industry as “producers”). They are pushing legislation that has been introduced in Congress and is now being studied by the National Association of Insurance Commissioners that…
Insurance Brokers and the Medical Loss Ratio December 8, 2011 Perspective 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…
Explaining Health Care Reform: Medical Loss Ratio (MLR) February 29, 2012 Fact Sheet 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.
Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision? June 6, 2013 Perspective The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) saved consumers an estimated $2.1 billion last year, in the form of lower premiums and rebates, according to a new analysis by the Kaiser Family Foundation. Under health reform, insurers must issue consumer rebates if they fail to spend a certain portion of premium income on health care claims and quality improvement expenses, thereby limiting what they may spend on administrative expenses or keep as profits.
The Economy and Medical Care November 15, 2011 Perspective Various market watchers have reported that the use of health care services has not been growing recently as it had in the past, resulting in lower than expected health care claims for people with private insurance and higher than expected earnings for insurers. A look at physician office visits by…
Strategies to Manage Unwinding Uncertainty for Medicaid Managed Care Plans: Medical Loss Ratios, Risk Corridors, and Rate Amendments April 10, 2023 Issue Brief This 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.
Insurer Financial Performance in the Early Years of the Affordable Care Act April 21, 2017 Issue Brief 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.
Analysis: Insurer Financial Indicators Show Signs of Stabilizing After Transition to ACA Marketplaces April 21, 2017 News Release A new Kaiser Family Foundation analysis of key insurer financial indicators suggests that the individual insurance market showed signs of stabilizing in 2016, although profitability remained below the level of performance prior to the opening of the Affordable Care Act’s insurance marketplaces. The new analysis tracks insurer financial performance in…
Individual Insurance Market Performance in 2017 May 17, 2018 Issue Brief This brief examines recently-released annual financial data from 2017 and finds insurers selling individual market plans had their best financially since 2014, when new ACA insurance market rules took effect that guaranteed access to coverage for people with pre-existing conditions. At the same time, recent political and policy changes, including the repeal of the individual mandate penalty as part of tax reform legislation and proposed regulations to expand loosely-regulated short-term insurance plans, cloud plans’ outlook going forward.