Data Note: 2019 Medical Loss Ratio Rebates – Methods

This analysis was updated on September 25 to correct an error that excluded about $62 million of small group rebates in California and about $100,000 of large group rebates in California.

This analysis is based on information insurers submit to the Centers for Medicare and Medicaid Services. In the individual market, the number of subscribers owed a rebate is similar to the number of families or households purchasing coverage (including families of one); this total does not include dependents and therefore is smaller than the number of covered lives or individuals who are owed a rebate. In the small group and large group market, we show the number of employers; this is a count of the number of groups and not the number of people eligible for a rebate.

The rebate amounts include $0.9M in de minimis rebates, and about 198,000 subscribers or employers whose rebate is de minimis.

The average payment per subscriber is the total amount owed in rebates in the individual market divided by the total number of subscribers owed a rebate in the individual market. Three insurers across 18 states reported owing rebates but did not report the number of subscribers owed a rebate. In Table 3, we suppress the number of subscribers and the average amount of rebates when at least one insurer in the state failed to report the number of subscribers owed a rebate. None of the figures in this analysis include mini-med plans.

At least 12 insurers did not file rebate data as of August 10. We suppress rebates in Kansas, Montana, Nevada, and North Dakota because insurers that make up more than 10% of enrollment in those states did not file MLR data.

We calculate the percent of rebates paid out in a lump sum or premium credit by dividing the total dollars in rebates being paid out in that form by the total dollars in rebates for which form of payment information is available.

To merge issuers onto their parent companies in Table 2, we used the NAIC code included in the insurers’ rebate reports and parent company data from Mark Farrah Associates TM.