The medical loss ratio provision of the ACA limits how much payers can keep in premium income to use on administrative and marketing costs, or for profits. Rebates are sent back to members if the payer does not meet the threshold ratio required.
KFF’s analysis estimates that rebates issued later this year will surpass last year’s $947 million total but will fall short of the record-high rebate totals of $2.5 billion in 2020 and $2 billion in 2021. KFF originally estimated $1.1 billion in rebates in 2023.
Preliminary 2024 estimates of payer rebates:
All markets
Total rebates: $1.1 billion
Individual market
Total rebates: $550 million
Small group market
Total rebates: $286 million
Large group market
Total rebates: $217 million
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 17–19 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
