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Commercial Health Plans’ Medical Loss Ratio [2nd Quarter 2013]

3 Responses

1. Ann Miller RN MHA, on March 6, 2014 at 6:37 PM said:

   2013 Fourth Quarter and Full Year Commercial Medical Loss Ratio for Selected Major Health Plans

   QTR4 2013 YTD 2013

   Aetna 81.70% 80.10%
   Centene** 90.40% 90.40%
   CIGNA 86.60% 81.50%
   HealthNet 87.40% 85.60%
   Humana* 82.50% 81.00%
   Molina 86.20% 86.10%
   WellPoint 79.20% 81.80%
   United Health Group 83.50% 81.00%

   *Humana MCR actually is categorized by Retail and Employer Group. Employer Group is categorized as Commercial for this presentation.
   ** Centene Medicaid and CHIP MLR is in place of commercial

   Source: Financial reports of selected health plans; linked to in table

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2. Ann Miller RN MHA, on April 14, 2015 at 7:24 PM said:

   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.

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3. Lawrence, on April 27, 2017 at 6:06 PM said:

   The Individual Market Medical Loss Ratio Was 96% in 2016

   Kaiser Family Foundation recently released an analysis on the individual insurance market. Here are some key findings from the report:

   • 7% of the U.S. population gets their insurance from the individual market.
   • In 2015, the average individual market medical loss ratio grew to 103%.
   • Gross margins per member per month fell from $37.20 in 2013 to $6.54 in 2014.
   • In 2015, average gross margins per member per month dropped to -$10.17.
   • In the individual market in 2016, the average medical loss ratio was 96%.
   • The average gross margins per member per month was $13.54 in 2016.

   Source: Kaiser Family Foundation, April 21, 2017

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