Missouri’s biggest individual insurer must rebate almost $90 million to policyholders because it spent too little on care and too much on administration.
Ambetter from Home State Health, a subsidiary of Clayton-based Centene Corporation, is mailing checks totaling $87.5 million to customers in Missouri because it violated the Medical Loss Ratio requirements of the Affordable Care Act, also known as Obamacare. Letters dated Sept. 10 notifying policyholders of the rebates — equal to more than one month’s premium for each — began arriving in mailboxes during the last week or so.
One of Ambetter’s competitors, United Healthcare, is also making rebates to Missouri customers. In a Sept. 5 statement, United Healthcare said it will rebate $192.2 million nationally for group market plans offered in 31 states and $167.1 million for individual insurance market plans offered in 19 states.
Missourians in both United Healthcare markets will be eligible for rebates but the material supplied by the company did not show the amounts.
The rebates from Ambetter are among the largest for individual insurance companies operating in the Missouri marketplace since the Affordable Care Act began requiring them in 2012. Over 12 years, insurers have rebated $587.1 million to Missouri policyholders, with the most being $192.7 million in 2019.
“This is a standard and required process under the Affordable Care Act that ensures health plans return a portion of premiums to members if spending on medical care falls below federal thresholds,” Centene said.
This article originally appeared here.