Friday, April 17, 2015

Medical Loss Ratios and Rebates by Insurance Market Segment


According to an issue brief by the Commonwealth Fund:

Individual market:

  • Median adjusted MLR - 84.9%
  • Percent of credible insurers owing rebate - 31%
  • Median rebate per member - $100
  • Total rebate paid (in millions) - $128.2

Small-group market

  • Median adjusted MLR - 85.0%
  • Percent of credible insurers owing rebate - 18%
  • Median rebate per member - $29
  • Total rebate paid (in millions) - $117.7

Large-group market

  • Median adjusted MLR - 89.3%
  • Percent of credible insurers owing rebate - 13%
  • Median rebate per member - $61
  • Total rebate paid (in millions) - $79.0

Note: Date from 2013. Insurers with actuarial "credibility" are those with enough enrollment to be subject to the MLR rule. Adjusted MLRs are defined in note 8 on page 10. n=747 for the individual market, n=667 for the small-group market, n=697 for the large-group market.


Source: Authors' analysis of Centers for Medicare and Medicaid Services medical loss ratio and rebate data

No comments:

Post a Comment