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PPACA Rebates would Have Been Sizable in 2010

The Commonwealth Fund released a study recently that determines that consumers would have received rebates of nearly $2 billion if PPACA’s minimum medical loss ratio (MLR) provision were in force for 2010.

The minimum MLR requirement, which kicks in for the 2011 calendar year, calls for rebates back to consumers if plans’ individual and small group MLRs are below 80% and if large group MLRs are below 85%. The medical loss calculation includes typical medical claims and quality spending, but excludes almost all administrative spending. A Medicare Advantage Part C minimum MLR of 85% comes into force in 2014.

It is unclear if the $2 billion figure will hold for 2011. 2011 rebate checks are due to eligible members in August. Commonwealth says that a quarter of consumers would have received rebates in 2010, with 50% of those with individual coverage receiving a rebate. Rebates would have been on average between $100 to $300 per member.

Residents in Texas and Florida would have received over $200 million.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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