Insurer accountability · 2024 MLR reporting year · CMS MLR PUF

Did your insurer spend your premiums on care — or owe you money back?

The ACA's "80/20 rule" requires a health insurer to spend at least 80% of premium dollars (85% in the large-group market) on actual medical care and quality improvement — its Medical Loss Ratio. Spend more on administration, marketing, and profit than the rule allows, and the insurer must rebate the difference to its policyholders.

$1.7B

total rebates owed (2024)

200

insurers that owed a rebate

855

issuer-in-state filings

$594B

premium earned (2024)

That's 0.29% of premium returned — a small slice overall, but a hard, rule-based refund concentrated in the insurers that underspent. By reported parent group, Centene CORP GRP filings account for 7 of the 25 largest rebates below.

Where the rebates come from

By insurance market. The individual market — where most ACA marketplace shoppers buy — drives the largest rebates.

Individual $1.2B · 84 of 481 filings below the floor

Small group $306M · 72 of 446 filings below the floor

Large group $207M · 91 of 625 filings below the floor

The largest rebates owed

The 25 insurer-in-state filings that owed the most for 2024, with the lowest Medical Loss Ratio across their markets. A low MLR means a smaller share of premiums went to care. Open any insurer for the full breakdown.

Absolute Total Care, Inc South Carolina · lowest MLR 74.0% $124M UnitedHealthcare Insurance Company Alabama · lowest MLR 69.9% · Unitedhealth GRP $114M Celtic Insurance Company Texas · lowest MLR 74.2% · Centene CORP GRP $112M Ambetter of North Carolina Inc. North Carolina · lowest MLR 73.5% $96M Celtic Insurance Company Missouri · lowest MLR 71.4% · Centene CORP GRP $88M Celtic Insurance Company Oklahoma · lowest MLR 66.6% · Centene CORP GRP $80M Celtic Insurance Company Alabama · lowest MLR 69.4% · Centene CORP GRP $67M Ambetter Health of Louisiana, Inc. Louisiana · lowest MLR 65.3% $62M Celtic Insurance Company Florida · lowest MLR 79.2% · Centene CORP GRP $50M Buckeye Community Health Plan Ohio · lowest MLR 71.3% · Centene CORP GRP $45M Healthy Alliance Life Insurance Company Missouri · lowest MLR 70.5% · Elevance Hlth Inc Grp $45M Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Massachusetts · lowest MLR 85.0% · BCBS of MA Grp $44M Celtic Insurance Company Indiana · lowest MLR 74.1% · Centene CORP GRP $40M HMO Louisiana Louisiana · lowest MLR 75.7% · Louisiana HLTH SERV GRP $35M Independence Assurance Company GRAND TOTAL · lowest MLR 77.4% · Independence BLUE Cross GRP $30M Independence Assurance Company Pennsylvania · lowest MLR 77.4% · Independence BLUE Cross GRP $30M HealthKeepers, Inc. Virginia · lowest MLR 77.2% · Elevance Hlth Inc Grp $24M Blue Cross Blue Shield of Louisiana Louisiana · lowest MLR 70.5% · Louisiana HLTH SERV GRP $22M Anthem Insurance Companies, Inc. Indiana · lowest MLR 75.4% · Elevance Hlth Inc Grp $21M UnitedHealthcare Insurance Company Missouri · lowest MLR 76.4% · Unitedhealth GRP $20M Oxford Health Insurance, Inc. New Jersey · lowest MLR 82.3% · Unitedhealth GRP $18M Mass General Brigham Health Plan, Inc Massachusetts · lowest MLR 84.8% $17M Health Plan of Nevada, Inc. Nevada · lowest MLR 83.0% · Unitedhealth GRP $17M CareFirst BlueChoice, Inc. Maryland · lowest MLR 78.4% · Carefirst INC GRP $17M QualChoice Arkansas · lowest MLR 68.5% · QualChoice Holdings Inc. $16M

Looking for a specific insurer? Every one of the 855 issuer-in-state filings has a page at /coverage/mlr/<issuer> (linked from the leaderboard and the company directory), and all are in the sitemap.

RECORDED — the Medical Loss Ratio, the 80/85% standard, premium earned, and the rebate owed are CMS-published figures for the 2024 MLR reporting year (a three-year window through 2024; rebates are paid the following year). DERIVED — rebate as a share of premium, and the national totals (sums across filings).

Machine-readable: JSON-LD · Markdown · Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year

What this is — and is not

The MLR is a backward-looking measure of how an insurer spent premium dollars across its whole book of business in a market and state — it is not a measure of any individual plan's quality, your denial odds, or whether a plan is right for you, and it is not advice. A high MLR is not automatically "good," nor a low one automatically "bad" — but the rebate is a hard, rule-based consumer protection. If you were owed a rebate, your insurer pays it as a check or premium credit. To shop or enroll, see HealthCare.gov.