---
title: PacificSource Health Plans — Medical Loss Ratio & rebates (Montana, 2024)
license: CC0-1.0
source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year
---

# PacificSource Health Plans — Medical Loss Ratio & rebates (Montana, 2024)

Medical Loss Ratio and rebate outcomes for PacificSource Health Plans (parent group: PacificSource Hlth Plan Grp, as reported) in Montana, 2024 MLR reporting year, by market: individual 92.4%, small group 91.1%, large group 86.9%. Met the 80/20-rule floor in every market; no rebate owed. RECORDED CMS-published MLR / standard / premium / rebate; rebate-as-%-of-premium is DERIVED. A spending ratio across the whole book in a market — not plan quality or advice. CC0.

## Claims

### PacificSource Health Plans spent 92.4% of individual premiums on care in MT (2024)

**RECORDED.** In the Montana individual market, PacificSource Health Plans's three-year credibility-adjusted Medical Loss Ratio was 92.4% against the 80% floor, on $80,698,604 of 2024 premium earned. It met the floor; no rebate owed. RECORDED CMS-published figures (occurred=true; an actual backward-looking ratio insurers report under the 80/20 rule, adjudged=TRUE — CMS published it); rebate-per-enrollee is a DERIVED sub-figure.

Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year — https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
Falsifier: A RECORD of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### PacificSource Health Plans spent 91.1% of small group premiums on care in MT (2024)

**RECORDED.** In the Montana small group market, PacificSource Health Plans's three-year credibility-adjusted Medical Loss Ratio was 91.1% against the 80% floor, on $98,541,005 of 2024 premium earned. It met the floor; no rebate owed. RECORDED CMS-published figures (occurred=true; an actual backward-looking ratio insurers report under the 80/20 rule, adjudged=TRUE — CMS published it); rebate-per-enrollee is a DERIVED sub-figure.

Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year — https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
Falsifier: A RECORD of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### PacificSource Health Plans spent 86.9% of large group premiums on care in MT (2024)

**RECORDED.** In the Montana large group market, PacificSource Health Plans's three-year credibility-adjusted Medical Loss Ratio was 86.9% against the 85% floor, on $34,526,568 of 2024 premium earned. It met the floor; no rebate owed. RECORDED CMS-published figures (occurred=true; an actual backward-looking ratio insurers report under the 80/20 rule, adjudged=TRUE — CMS published it); rebate-per-enrollee is a DERIVED sub-figure.

Source: CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year — https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
Falsifier: A RECORD of measured/reported events (occurred=true) from CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year; superseded when CMS — Medical Loss Ratio (MLR) Public Use File, 2024 reporting year publishes its next release.

### What a Medical Loss Ratio is — and is NOT

**INTERPRETATION.** A Medical Loss Ratio is a spending ratio across an issuer's WHOLE book in a market for a past period — the share of premium spent on care + quality improvement versus administration and profit. It is NOT a measure of plan quality, of your individual plan's value, or of coverage availability, and it is NOT advice. A low MLR triggers a rebate; it does not rate care.

Source: Coverage Atlas L5 boundary (a book-level spending ratio ≠ plan quality) — https://coverage-atlas.ryanjhunter.workers.dev/
Falsifier: occurred=FALSE (a framing, not an event) and adjudged=FALSE (an in-house reading, not an authority's verdict) — the LOWEST-warrant claim here. A flat representation would render this identically to the official facts; the four-status does not.

---

Every claim above carries a four-status warrant (RECORDED / MODELED / DERIVED / INTERPRETATION) and a named source you can re-fetch — this is a research object, not a flat fact. Structured: `https://coverage-atlas.ryanjhunter.workers.dev/coverage/mlr/23603-mt.jsonld`

## Data

### Medical Loss Ratio by market — PacificSource Health Plans (Montana, 2024)

CMS-published credibility-adjusted MLR, standard, premium, and rebate (RECORDED). Rebate-per-enrollee is DERIVED.

| Market | 3-yr MLR | Floor | Met floor? | Premium (2024) | Rebate owed | Per enrollee | Warrant |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Individual | 92.4% | 80% | yes | $80,698,604 | $0 | — | RECORDED |
| Small group | 91.1% | 80% | yes | $98,541,005 | $0 | — | RECORDED |
| Large group | 86.9% | 85% | yes | $34,526,568 | $0 | — | RECORDED |