What is a medical loss ratio (MLR) rebate, and when would a consumer receive one?

Under the ACA, health insurers must spend at least 80% of premium revenue on medical care and quality improvement for individual and small group markets, and 85% for large group markets. If an insurer does not meet this minimum MLR, it must issue a rebate to policyholders. Rebates are typically delivered as a check, a premium credit, or a reduction in future premiums. Insurers paid out approximately $1 billion in MLR rebates to consumers in 2023. If you receive an MLR rebate check, it represents money the insurer collected from you in premiums beyond what was needed to fund actual healthcare costs.