Impact of Healthcare Consumers Essay Discussion Paper

ANSWER.

The percentage of premium dollars that a health insurance provider spends on medical bills compared to the percentage that it spends on overhead, marketing, and profits is measured by a financial indicator known as the medical loss ratio, or MLR. A minimum MLR, or the percentage of premium dollars that must be spent on healthcare costs, is what the Affordable Care Act (ACA) requires of health insurance providers.

Health insurance providers are mandated by the Affordable Care Act (ACA) to adhere to a minimum MLR. Depending on whether the insurance provider offers coverage to individuals, small groups, or large groups, the minimum MLR varies. The minimum MLR for individual and small group markets is set at 80%, which means that health insurance providers must devote at least 80% of the premium money they receive to healthcare costs. The minimal MLR for the large group market is 85%.

Prescription medicines, various healthcare services, as well as payments for medical and hospital services, all fall under the heading of healthcare expenses. Healthcare expenses do not include overhead, earnings, or marketing. Expenses for managing the insurance program, processing claims, and other administrative tasks are included in the category of administrative costs.

A health insurance provider must give refunds to its clients if it falls short of the minimum MLR standard. Based on the difference between the MLR the company actually obtained and the minimal MLR required by law, rebates are computed. Normally, the refunds are given in the form of a check or a credit that can be used to future premiums.

A health insurance company’s Medical Loss Ratio (MLR), a financial indicator, compares the proportion of premium dollars it spends on medical bills to the proportion on administrative, marketing, and profit expenses. A minimum MLR, or the percentage of premium dollars that must be spent on healthcare costs, is what the Affordable Care Act (ACA) requires of health insurance providers. In particular, the ACA mandates that health insurance providers in the individual, small group, and large group marketplaces must devote at least 80% of premium revenue to healthcare costs and quality improvement efforts.

Health insurance providers are required to give their clients a rebate if they fall short of the minimum MLR standard. The MLR requirement attempts to lower the cost of and increase consumer access to health insurance.  Impact of Healthcare Consumers Essay Discussion Paper