The Affordable Care Act (ACA) medical loss ratio (MLR) provision requires commercial health insurance providers to spend a certain percentage of premiums on medical care and limits the portion of premium dollars that can be spent on administration, marketing, and profits. In the individual and small group markets, health insurance providers must spend at least 80% of premiums on claims and quality improvement.
Resources
Impact of COVID-19 on 2021 Commercial MLR Rebates
Policy
- Related Issues
- Employer-Provided Coverage
- Individual Coverage