The Centers for Medicare and Medicaid Services has given U.S. health insurers bad news and good news about how individual health coverage performed in 2016.
The bad news is that rising claims ate up more premium revenue, squeezing underwriting gains.
The good news is that fewer insurers earned enough to owe rebates to the enrollees.
CMS published data on health insurers' 2016 performance in a new Affordable Care Act medical loss ratio (MLR) program report. A copy of the report is available here.
The Affordable Care Act minimum MLR provision requires issuers of non-grandfathered major medical coverage to spend at least 80 percent of individual and small-group premium revenue on health care and quality improvement activities. Issuers that miss the MLR target are supposed to pay rebates.
For large-group coverage, the minimum MLR is 85 percent of revenue.
Here's what happened to the insurers in 2016:
|Individual
The average MLR increased to 92.9 percent in 2016, from 91.8 percent in 2015.
The percentage of enrollees covered by issuers that paid rebates fell to 5 percent, from 6.7 percent.
The total amount of rebates paid increased to $103 million, from $107 million.
|Small group
The average MLR increased to 86.1 percent in 2016, from 85.6 percent in 2015.
The percentage of enrollees covered by plans that paid rebates fell to 9.9 percent, from 13.1 percent.
The total amount of rebates paid increased to $153 million, from $154 million.
|Large group
The average MLR increased to 90.3 percent in 2016, from 90.1 percent in 2015.
The percentage of enrollees covered by plans that paid rebates fell to 3.8 percent, from 4 percent.
Although the percentage of people covered by large-group plans paying rebates fell, the total amount of rebates paid increased to $191 million, from $136 million.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
