---
title: Did your health insurer spend your premiums on care? (ACA MLR rebates, 2024)
reporting_year: 2024
national_rebate_owed: 1705553881
issuers_owing_rebate: 200
issuer_state_filings: 855
source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year
sourceId: src:cms:mlr-puf:2024
---

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

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

For the **2024 MLR reporting year**, **200 insurers** across **855 issuer-in-state filings** owed **$1,705,553,881** in rebates, against $593,967,932,737 of premium earned — about **0.29%** of premium returned. By reported parent group, **Centene CORP GRP** filings account for 7 of the 25 largest rebates (many filings carry no group affiliation, so true concentration may be higher).

## Rebates by market

| Market | Rebates owed | Filings below the floor |
| --- | --- | --- |
| Individual | $1,192,050,593 | 84 of 481 |
| Small group | $306,186,541 | 72 of 446 |
| Large group | $207,316,747 | 91 of 625 |

## Largest rebates owed (2024)

| Insurer | State | Lowest MLR | Rebate owed |
| --- | --- | --- | --- |
| Absolute Total Care, Inc | South Carolina | 74.0% | $123,675,633 |
| UnitedHealthcare Insurance Company | Alabama | 69.9% | $113,927,888 |
| Celtic Insurance Company | Texas | 74.2% | $111,584,521 |
| Ambetter of North Carolina Inc. | North Carolina | 73.5% | $96,142,649 |
| Celtic Insurance Company | Missouri | 71.4% | $87,529,084 |
| Celtic Insurance Company | Oklahoma | 66.6% | $80,040,054 |
| Celtic Insurance Company | Alabama | 69.4% | $67,058,546 |
| Ambetter Health of Louisiana, Inc. | Louisiana | 65.3% | $62,151,515 |
| Celtic Insurance Company | Florida | 79.2% | $50,493,984 |
| Buckeye Community Health Plan | Ohio | 71.3% | $45,488,803 |
| Healthy Alliance Life Insurance Company | Missouri | 70.5% | $45,313,980 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | Massachusetts | 85.0% | $43,721,415 |
| Celtic Insurance Company | Indiana | 74.1% | $40,112,980 |
| HMO Louisiana | Louisiana | 75.7% | $35,449,527 |
| Independence Assurance Company | GRAND TOTAL | 77.4% | $30,255,539 |
| Independence Assurance Company | Pennsylvania | 77.4% | $30,255,539 |
| HealthKeepers, Inc. | Virginia | 77.2% | $23,554,741 |
| Blue Cross Blue Shield of Louisiana | Louisiana | 70.5% | $22,129,741 |
| Anthem Insurance Companies, Inc. | Indiana | 75.4% | $21,483,952 |
| UnitedHealthcare Insurance Company | Missouri | 76.4% | $19,603,158 |
| Oxford Health Insurance, Inc. | New Jersey | 82.3% | $18,428,984 |
| Mass General Brigham Health Plan, Inc | Massachusetts | 84.8% | $17,189,710 |
| Health Plan of Nevada, Inc. | Nevada | 83.0% | $16,830,071 |
| CareFirst BlueChoice, Inc. | Maryland | 78.4% | $16,702,930 |
| QualChoice | Arkansas | 68.5% | $16,062,814 |

Every issuer-in-state filing has a page at `/coverage/mlr/<issuer>` (+ `.jsonld`/`.md`) with its MLR by market and the rebate owed.

RECORDED CMS-published MLR / standard / premium / rebate (MLR credibility-adjusted over the three-year window through 2024; premium is the current year; rebates paid the following year); national totals and rebate-per-enrollee are DERIVED. A spending ratio across an insurer's whole book in a market — **not** a plan's quality, your denial odds, or advice. Source: https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio

Structured data: `/coverage/mlr.jsonld`