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MLR Statute Credited with $3.4B Insurance Premium Cut

Margaret Dick Tocknell, for HealthLeaders Media, June 24, 2013

"They realized that the downturn in healthcare cost growth was not just a blip and they needed to align premiums more closely with those costs," Jost told HealthLeaders Media. The MLR provides "strong encouragement to take that step" by requiring rebates to be paid by insurers with for MLR excesses. Thus insurers have been paying more attention to administration components such as marketing costs and broker fees.

For 2012 the rebates were about 50% lower, $504 million, while the number of consumers in line to receive a rebate fell by 34% to 8.5 million.

Last year was the first time CMS identified a corresponding premium savings. Among the components of the $3.4 billion premium reduction, the large group market accounted for 43% or $1.5 billion, while the individual and small group markets each accounted for 28%, or $980 million and $970 million, respectively.

Jost notes that the large group market typically has a better understanding of costs and is "probably much more accurate in projecting premiums," which is reflected in its significant contribution to the premium reduction.

By contrast, the small group market is challenged in identifying risks, probably charges a risk premium, and is more likely to "overestimate costs, charge higher premiums, and then pay a rebate," says Jost.

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