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Centers for Medicare & Medicaid Services

Medical Loss Ratio

  • The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. MLR requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the review provisions imposing tighter limits on health insurance rate increases. If they fail to meet these standards, the insurance companies are required to provide a rebate to their customers starting in 2012.
  • Update: Insurers must submit a report each year to the Department of Health and Human Services (HHS) showing how much the insurer spent on health care and activities that improve care in the past year. Each year's report is due by July 31 of the following year. For example, an insurer must submit its yearly report for 2016 by July 31, 2017. Learn more about Medical Loss Ratio.
  • Each insurer’s Medical Loss Ratio information is provided separately for each state and, within each state, by market (individual, small group and large group markets). It is not provided by a particular plan, product, or policy.

Use the search tool below to find an insurer’s Medical Loss Ratio report for an applicable Reporting Year. To get started, select a state. If you select only one state, you may either enter the name of a company you wish to see or you may click the Search button without entering the name of an insurance company. If you select only one state and you click the Search button without entering the name of an insurance company, the results will list the MLR reports of all of the companies that submitted an MLR report for that state. If you select more than one state or territory, you must enter the name of a company. The MLR reports will be listed with a link to a ZIP file that you may download. The ZIP file for each company contains a separate Excel document for every state that the company does business in, even if you selected a single state in the search tool.

Note: the search tool only lists results for insurers that have submitted an MLR report.

Step 1 – Reporting Year and State Selection

Please use the following list to select an applicable Reporting Year, and one or more states and/or territories. You must select a Reporting Year and at least one state and/or territory.
Note: You may select one or more state(s) and/or territories by holding the CTRL key and selecting with the mouse. Keyboard only users may select one or more state(s) and/or territories by holding the SHIFT key and using the appropriate arrow keys on the keyboard.

An asterisk (*) indicates a required field