In the latest Healthcare Business Strategy report, Mark Farrah Associates, www.markfarrah.com, summarized key findings from the 2021 MLR report released by the Department of Health and Human Services (HHS). The Affordable Care Act’s (ACA) MLR provision requires health insurers who fail to spend specified percentages of their health care premium income to pay rebates to their customers. The goal of this provision is to curb growth in health care premiums while ensuring that plans are adequately covering healthcare expenses. This brief focused on health plan performance as it relates to the Medical Loss Ratio, and the related rebates subsequently due to consumers.
Key highlights include:
- For 2021, increases in medical spending outpaced premium growth, leading to increased MLRs overall, slashing rebates to approximately $1 billion, benefitting 6.2 million customers, equating to approximately $167 per beneficiary.
- For 2021, Pennsylvania led the country with nearly $176 million in MLR rebates, a 2% increase from 2020.
- 2021 MLR rebates paid for the Individual segment were $486 million, which is .5% of the $95.3 billion collected in premiums.
- MLR Rebates for the Small Group segment were $362 million, or 0.50% of the $72.3 billion segment.
- 2021 MLR rebates for the $245 billion Large Group segment were $183 million.
Subscribers to Mark Farrah Associates' Health Coverage Portal and the SHCE and MLR Data have access to this dataset with the benefit of NAIC company codes mapped to HIOS codes used for government reporting by health plans. To read the full text of "A Brief Summary of the 2021 Health Insurance Medical Loss Ratio and Rebates Results", visit the MFA Briefs on Mark Farrah Associates' website.
About Mark Farrah Associates (MFA)
MFA is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Committed to simplifying analysis of health insurance business, our products include: Health Coverage Portal™, Medicare Business Online™, Medicare Benefits Analyzer™, County Health Coverage™, Health Plans USA™ and 5500 Employer Health Plus. Follow us on LinkedIn!
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