Medical Loss Ratio

Source CMS

The Center for Consumer Information & Insurance Oversight states the following:

"The Affordable Care Act requires health insurance companies to disclose how much they spend on health care and how much they spend on administrative costs, such as salaries and marketing. If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must refund the portion of premium that exceeded this limit. This rule is commonly known as the 80/20 rule or the Medical Loss Ratio (MLR) rule."

Pre-Stata13 had a string length limit of 244 characters. Some files such as Part 4, Part 6, and Additional Responses 2 for some years have long strings ( > 244 characters ). They are saved in full length and length == 244 versions.

CMS offers an MLR reports by State and Company Name searchable database and other helpful resources.

Updates and changes.

Year

All Source
Data Files
and Docs

Doc

In-
struc-
tions

Forms

Row Lookup

Header

Part 1 and 2
Summary of Data
and
Premium and Claims

Part 3
Expense Allocation Methodology

Part 4
MLR and Rebate Calculation

Stata

SAS

CSV

Desc

Stata

SAS

CSV

Desc

Stata

SAS

CSV

Desc

Stata

SAS

CSV

Desc

Stata

SAS

CSV

Desc

2013

Medical Loss Ratio

Related

Topics

Data Categories

More from NBER