ACA’s 2016 medical loss ratio rebates

The Affordable Care Act's '80/20' rule delivered $397 million in premium refunds to 4.9 million Americans in 2015, its fifth year

The Affordable Care Act's medical loss ratio (MLR) returned $397 million to 4.9 million American consumers in its fifth year.

The Affordable Care Act’s requirement that health insurance companies spend 80 percent of your premium dollars on actual health care – rather than marketing, administrative and CEO salaries – returned $397 million to 4.9 million American consumers in its fifth year.

The medical loss ratio – also known as the 80/20 rule – means that insurers for the first time have to disclose where they’re spending plan holder premium dollars. If they spend less than 80 percent (less than 85 percent for large group plans) on providing medical care, they must rebate the excess dollars back to consumers each year.

The medical loss ratio has returned billions in health insurance premium rebates to consumers since 2012.

The average American household received $129 in the fifth year, with the highest rebates in Hawaii ($1,339), Kansas ($599) and Texas ($497). See the statistics for your state below.

ACA’s 2016 medical loss ratio rebates
State Total Rebates Consumers Benefiting Average per Family
Alaska $55,840 89 $235
Alabama $1,252,727 7,792 $249
Arkansas $3,928,423 86,923 $58
Arizona $5,750,456 58,430 $185
California $37,164,457 294,867 $233
Colorado $1,737,038 5,975 $376
Connecticut $44,646 1,353 $66
District of Columbia $18,066,004 252,986 $155
Delaware $190,367 4,050 $90
Florida $46,172,885 766,290 $95
Georgia $20,132,607 226,595 $141
Hawaii $1,167,943 1,598 $1,339
Iowa $1,512,470 20,058 $133
Idaho $80,459 219 $155
Illinois $2,924,775 37,719 $123
Indiana $15,554,175 234,936 $104
Kansas $1,881,472 4,994 $599
Kentucky $3,640,398 85,025 $52
Louisiana $419,989 3,220 $168
Massachusetts $353,864 61,274 $114
Maryland $45,755,797 296,255 $273
Maine $0 0 $0
Michigan $34,316,590 635,603 $120
Minnesota $65,797 1,508 $70
Missouri $20,912,406 273,246 $116
Mississippi $15,692,881 92,382 $256
Montana $0 0 $0
North Carolina $8,270,684 57,865 $203
North Dakota $0 0 $0
Nebraska $6,243,165 747 $254
New Hampshire $7,705,129 40,609 $304
New Jersey $2,634,720 116,900 $42
New Mexico $1,179 98 $4
Nevada $6,243,165 29,244 $363
New York $46,661,492 458,400 $149
Ohio $8,684,809 143,202 $89
Oklahoma $2,038,937 26,240 $143
Oregon $164,973 9,601 $26
Pennsylvania $859,761 13,941 $92
Rhode Island $1,954,106 15,651 $150
South Carolina $705,649 99,835 $11
South Dakota $0 0 $0
Tennessee $2,577,775 26,887 $161
Texas $7,847,249 21,015 $497
Utah $201,211 1,172 $287
Virginia $19,217,933 301,325 $102
Vermont $0 0 $0
Washington $464,382 3,328 $246
Wisconsin $742,480 23,502 $53
West Virginia $839,245 7,608 $211
Wyoming $0 0 $0
American Samoa N/A N/A N/A
Guam N/A N/A N/A
Northern Mariana Islands N/A N/A N/A
Puerto Rico N/A N/A N/A
Virgin Islands N/A N/A N/A

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Louise Norrismaria de los angeles hernandeez Recent comment authors
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maria de los angeles hernandeez
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maria de los angeles hernandeez

i show that in 2016 policy #03w1934 and 2017 policy # 03w1934 i was owed a rebate and i never received nothing c an you please explain

Louise Norris
Editor

Maria,
The details for the insurers that owed rebates are here (see the links under each reporting year; MLR rebates are paid out the following year): https://www.cms.gov/CCIIO/Resources/Data-Resources/mlr
It’s possible that your insurer applied the rebates as a premium credit rather than sending a lump-sum check. But if you believe that your plan should have been MLR rebate-eligible and the rebate was not paid, you can contact your insurer directly and ask them to look into it.

maria de los angeles hernandeez
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maria de los angeles hernandeez

i did and they advised they ever received anything

Louise Norris
Editor

I’m not sure what they’d be referring to in terms of not receiving anything. The insurance companies are the ones that file the MLR data with CMS, and the details are publicly available in terms of which insurers have to pay rebates and whether they’re in the individual, small group, or large group market. If you’ve contacted your insurer and they’re unable to explain why you didn’t receive an MLR rebate, you could try calling your state’s insurance department and asking them to look into it. Here’s contact information for each state: https://content.naic.org/state_web_map.htm But just in case there’s a misunderstanding,… Read more »