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Medical-Loss-Ratio-Graphic

Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision?

The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) saved consumers an estimated $2.1 billion last year, in the form of lower premiums and rebates, according to a new analysis by the Kaiser Family Foundation. Under health reform, insurers must issue consumer rebates if they fail to spend a certain portion of premium income on health care claims and quality improvement expenses, thereby limiting what they may spend on administrative expenses or keep as profits.

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home-promo-map-excchange

State Health Insurance Marketplace Profiles

Up-to-date state profiles give an in-depth look at each state’s progress in setting up marketplaces, formally known as exchanges, including the legislative process and the next steps.

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The Henry J. Kaiser Family Foundation

A Profile of Health Insurance Exchange Enrollees

The Patient Protection and Affordable Care Act calls for the creation of Health Insurance Exchanges in all states by January 1, 2014. The exchanges are a critical element of the health reform law, aimed at helping individuals and families shop for and purchase health insurance on their own with additional…

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Flip Side

The Flip Side of Higher Premiums: Better Coverage

Time Magazine’s recent cover story on health care – “Bitter Pill” by Steven Brill – has focused attention on hospital prices, especially for people paying out of their own pockets. This is not a new issue, but certainly one that deserves attention. However, what has been lost in the ensuing…

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The Henry J. Kaiser Family Foundation

California Health Care Chartbook: Key Data and Trends

This chartbook provides California and U.S. data and trend analysis on a broad range of health system and financing indicators, including demographics and health status data, insurance coverage and the uninsured, employer health insurance premiums and offer rates, Medicaid and Medicare enrollment and spending, and health care industry trends. Chartbook…

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The Henry J. Kaiser Family Foundation

External Review of Health Plan Decisions: An Overview of Key Program Features in the States and Medicare

In 1978, the state of Michigan established a system to call on independent medical experts to help resolve disputes between health plans and patients about the medical necessity and appropriateness of care. Since then, twelve other states and the Medicare program have established similar kinds of external review programs. In…

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The Henry J. Kaiser Family Foundation

Explaining Health Care Reform: Medical Loss Ratio (MLR)

This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and businesses.

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The Henry J. Kaiser Family Foundation

The Cost of Cancer

This Kaiser Family Foundation documentary explores the financial consequences faced by three people, all privately insured, after being diagnosed with cancer. It was released in conjunction with a joint Kaiser/American Cancer Society report, “Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System.” To download the video, right-click…

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The Henry J. Kaiser Family Foundation

The Requirement to Buy Coverage Under the Affordable Care Act

Along with changes to the health insurance system that guarantee access to coverage to everyone regardless of pre-existing health conditions, the Affordable Care Act includes a requirement that many people be insured or pay a penalty. This simple flowchart illustrates how that requirement (sometimes known as an “individual mandate”) works.…

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employer-penalty-flowchart-thumbnail-071513

Employer Responsibility Under the Affordable Care Act

This flowchart illustrates how and when penalties may be applied to employers not offering affordable health benefits under the Affordable Car Act (ACA).

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