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Now; I think the "medical loss ratio" requirements were one of the most important features of the ACA. One of the worst offenders from the before-times was an
by saalweachter 5y ago
Now; I think the "medical loss ratio" requirements were one of the most important features of the ACA.
One of the worst offenders from the before-times was an insurance plan targeted at college students that had a 10% MLR.
- kristjansson 5y agoTo save those looking it up: medical loss ratio is the fraction of premiums an insurer spends on actual healthcare expenses. 10% means 90 cents of every dollar paid in premium goes to admin/profit/etc.
- munk-a 5y agoI wonder how MLRs interact with subsidies, backroom deals and manufacturer rebates - if an payer can inflate their MLR by double paying for a medication - but then they get a rebate back for half the cost they paid will MLR tracking catch that? Payers often get incentivized to promote certain drugs via manufacturer kickbacks and I wonder if this system is also used to run around MLR requirements.