Wednesday, January 31, 2018

For first time, no CT insurers exceeded ACA medical payment standards in 2016

According to CMS, in 2016 Connecticut for the first time since passage of the Affordable Care Act (ACA), no insurers were required to provide rebates because they exceeded the ACA’s Medical Loss Ratio (MLR) standards. The MLR provision of the ACA required that insurers spend at least 80% of premiums for individual and small group plans and 85% for large groups on medical care and quality improvement. Insurers that do not meet the MLR standard must rebate that portion of premiums to employers and consumers. In 2013 Connecticut insurers issued $3 million in MLR rebates on behalf of 69,186 state residents. Connecticut insurers have improved premium setting to match medical and quality spending each year since then reducing rebates to $1.8 million in 2014 and $44,646 in 2015. Insurers in twelve states, including Connecticut, all met the MLR standard in 2016, up from only six states the year before.