Tag: medical loss ratio

Questionable Quality Improvement Expenses Drive Proposed Changes to Medical Loss Ratio Reporting

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Under the Affordable Care Act, insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold. Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on providers. Karen Davenport takes a look at how this practice impacts consumers, and explains a new federal proposal to crack down on it.

COVID-19 and MLR Guidance on Risk Corridor Recoveries: State Options for Restoring Funds to Policyholders and the Public

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The Supreme Court has required the federal government to reimburse health insurers for an estimated $12.3 billion in unpaid risk corridor funds and the Trump administration recently published guidance to insurers that affects the amount to be returned to policyholders. In an Expert Perspective for the State Health & Value Strategies program, Sabrina Corlette and Jason Levitis consider the effects of this guidance and state options for redirecting insurers’ extra cash to benefit policyholders and the public.

As Insurers Sit on Extra Cash, Are Premium Relief and MLR Rebates the Best Use of Funds?

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While the COVID-19 pandemic has prompted financial catastrophe across the country, the private health insurance industry appears to be thriving. CHIR researchers Megan Houston and Sabrina Corlette consider whether the traditional use of these extra funds is the best way to spend them and discuss opportunities that states may have to redirect money towards COVID-19 testing.

State Options Blog Series: Implications of Weakening the 80-20 Rule for States and Consumers

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The Trump administration recently issued a proposed regulation that could significantly impact how much of consumers’ premium dollars are spent on their health care needs. CHIR expert Kevin Lucia assesses the proposed relaxation of the Affordable Care Act’s “80-20” or medical loss ratio standards and outlines policy options for states wishing to maintain them.

Proposed 2019 Affordable Care Act Payment Rule: A Big Role for States

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The U.S. Department of Health & Human Services published an annual set of proposed rules for the Affordable Care Act marketplaces on October 27. Called the “Notice of Benefit and Payment Parameters,” the rules set out expectations for insurers and the states that regulate them. In her latest post for CHIR, Katie Keith highlights key areas in which this administration would give states new autonomy and authority.

Shifting into Post-Enrollment Issues: Fielding New Questions from Consumers

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As we approach the end of open enrollment into new coverage options under the Affordable Care Act, many consumers have questions about their new health plans – what benefits are covered, what doctors are included in their networks, and what to do if there’s a problem. JoAnn Volk has them covered, with a series of frequently asked questions about post-enrollment issues, excerpted from our Navigator Resource Guide.

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.