It is related to this “A Medical Loss Ratio (MLR) is the percentage of health insurance premium dollars an insurer spends on medical claims and quality improvement rather than administrative costs and profits. Rebate rule: Insurers failing to meet statutory targets over a three-year rolling average must issue financial rebates to consumers or policyholders.” Note the MLR is a state determined percentage.
I have gotten this rebate the past few years in MA.
State specific information is here:
https://www.beckerspayer.com/rankings-ratings/states-ranked-by-total-mlr-rebates/
I understand insurer refunds. I have yet to see the actuarial study that supports refunding the $500 in this particular case.
It’s odd the payment would be exactly $500 as opposed to $496.31 or $503.42.
Is it not also an admission, that hey, this marketplace was able to provide you insurance at a lower cost than you could get in the open market place, and it worked so well, we actually should have charged you less?
Reminder to keep political commentary out of this thread. Factual statements only please!
It does not look like the widely-reported $500 checks have anything to do with MLR.
I’d use it to buy yourself something you’d love but think is too expensive. If I get one that is my plan.
The $500 checks are reportedly being sent to those who bought through healthcare.gov (i.e. those not in states that have their own ACA enrollment web sites) and were paying the unsubsidized price (i.e. had higher income levels).
H & I each have $90 Medicare reimbursements pending in our bank account. I still haven’t seen how the MLR was calculated. No other comments here on our windfall. I am curious, though, whether anyone on an Advantage plan has received one.
People on Advantage plans are excluded, even though most pay the same Part B premium as those on “standard” Medicare:
So then what is the purpose?
I’m kind of baffled as well, and since this isn’t the PF, I’ll refrain from speculating.
Medicare Advantage isn’t the same as traditional Medicare, which is likely why those enrollees don’t qualify for the payments, she added.
Medicare Advantage is run by the insurance company, outside of traditional Medicare, although it aligns with traditional Medicare in terms of coverage (although restrictions on providers and hoops to jump through for approval are allowed). It makes sense that Advantage plans would be excluded given the reason for the refunds … which was why I wondered about payments to those on Advantage plans. If refunds are to be given, they would be refunded by the insurance company - which would have to be supported by Medical Loss Ratio calculations.
I haven’t seen anything in my bank account yet. I do not have a Medicare Advantage plan, I do have a Blue Cross Blue Shield supplement.
We can see pending payments, and that’s where it’s sitting right now.
We have two pending $90 deposits in our checking account; we both have Supplemental plans rather than Advantage.
I bought my plan through a broker but it was a marketplace plan. I paid full price but I’m in Ca so not sure if I’ll get anything
We have neither a supplemental plan nor an advantage plan. We just have our private insurance we had which we were allowed to keep in retirement. Coverage is excellent and coordination with Medicare A&B has been working fine.
IIRC! You have government funded health insurance as your spouse was a career government worker. Most people are not fortunate enough to have this coverage…really, it’s the exception and not the rule.
I am a member of a very large group. We have received our policy info for the upcoming year, and really, there is little change in benefits except that now we will get $600 every two years for new glasses or contacts instead of $500. Premium monthly increase was very small.