Medical Loss Ratio Data and System Resources
The Affordable Care Act requires health insurance companies to disclose how much they spend on health care and how much they spend on administrative costs, such as salaries and marketing. If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must refund the portion of premium that exceeded this limit. This rule is commonly known as the 80/20 rule or the Medical Loss Ratio (MLR) rule.
Search Tool
- Search for MLR reports by State and Company Name - Opens in a new window
Use the search tool to find an insurer's Medical Loss Ratio report for applicable reporting years.
2011 Reporting Year
- Public Use File for 2011 (as of November 26, 2012) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2011.
- List of Health Insurers Owing Refunds for 2011 (as of November 26, 2012) (PDF)
2012 Reporting Year
- Public Use File for 2012 (as of August 1, 2013) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2012.
- MLR Refunds by State and Market for 2012 (as of August 1, 2013) (PDF)
- List of Health Insurers Owing Refunds for 2012 (as of August 1, 2013) (PDF)
2013 Reporting Year
- Public Use File for 2013 (as of June 30, 2014) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2013
- MLR Refunds by State and Market for 2013 (as of June 30, 2014) (PDF)
- List of Health Insurers Owing Refunds for 2013 (as of June 30, 2014) (PDF)
2014 Reporting Year
- Public Use File for 2014 (as of October 7, 2015) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2014.
- MLR Refunds by State and Market for 2014 (as of October 7, 2015) (PDF)
- List of Health Insurers Owing Refunds for 2014 (as of October 7, 2015) (PDF)
2015 Reporting Year
- Public Use File for 2015 (as of October 19, 2016) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2015.
- MLR Refunds by State and Market for 2015 (as of October 19, 2015 (PDF))
- List of Health Insurers Owing Refunds for 2015 (as of October 19, 2015) (PDF)
2016 Reporting Year
- Public Use File for 2016 (as of October 19, 2017) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2016.
- Summary of 2016 MLR Results (PDF) (December 28, 2017)
2017 Reporting Year
- Public Use File for 2017 (as of December 5, 2018) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2017.
- MLR Refunds by State and Market for 2017 (PDF) (as of November 15, 2018)
- List of Health Insurers Owing Refunds for 2017 (PDF) (as of November 15, 2018)
2018 Reporting Year
- Public Use File for 2018 (as of October 1, 2019) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2018.
- MLR Refunds by State and Market for 2018 (as of September 30, 2019) (PDF)
- List of Health Insurers Owing Refunds for 2018 (as of September 30, 2019) (PDF)
2019 Reporting Year
- Public Use File for 2019 (as of October 20, 2020) (ZIP) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2019.
- MLR Refunds by State and Market for 2019 (as of October 16, 2020) (PDF)
- List of Health Insurers Owing Refunds for 2019 (as of October 16, 2020) (PDF)
2020 Reporting Year
- Public Use File for 2020 (ZIP) (as of October 21, 2021) This release contains the raw data submitted by insurance companies subject to Medical Loss Ratio reporting requirements in 2020.
- MLR Refunds by State and Market for 2020 (PDF) (as of October 21, 2021)
- List of Health Insurers Owing Refunds for 2020 (PDF) (as of October 21, 2021)
Updates
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation
*This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19. - April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)