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Insurance Brokers and the Medical Loss Ratio

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…

The Economy and Medical Care

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…

Improving the Financial Accountability of Nursing Facilities

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.

Analysis: Individual Market Insurers Experienced Their Best Financial Year under the ACA in 2017, Though Subsequent Political and Policy Changes Complicate the Outlook for Future Years

Insurers in 2017 had their best financial year selling individual market health insurance since the Affordable Care Act began requiring guaranteed access to coverage for people with pre-existing conditions in 2014, though recent political and policy changes create new challenges for insurers trying to succeed in this market, new Kaiser…

Proposed Rule on Medicaid Managed Care: A Summary of Major Provisions

This issue brief summarizes major provisions of the Notice of Proposed Rulemaking (NPRM) to modernize and strengthen federal Medicaid managed care regulations, which serves as an informational guide to key proposed new federal expectations and requirements of states and managed care arrangements, and federal oversight interests moving forward.

Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision?

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.

Individual Insurance Market Performance in 2017

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.

Who Will be the H&R Block and TurboTax for Health Insurance?

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…

As Policymakers Debate Medicare-for-All, Analysis Finds the Medicare Advantage, Individual and Group Health Insurance Markets Appear to Be Profitable, Especially Medicare Advantage

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, according to a new KFF analysis. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.