How market enrollees can claim a share of $603 million in rebates

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If you get your health insurance in the public market, you might want to keep an eye out for a check from your insurer.

Insurance companies are handing out $1 billion in rebates to 8.2 million policyholders starting this month. Of those, the majority — about $603 million — will go to people with a health plan through the federal health exchange or their state’s marketplace (if it has one), according to an estimate from the Kaiser Family Foundation.

The average rebate for market registrants is $141 per eligible attendee.

While not everyone who gets coverage this way gets a discount, it’s worth not ignoring mailings from your insurance company (or your insurer in 2021, if different).

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These rebates — which can occur every year, depending on the insurer — often arrive in the mail, said Cynthia Cox, vice president of the Kaiser Family Foundation and director of its Affordable Care Act program. And, she said, many checks in recent years have gone unclaimed.

“There are people missing,” Cox said.

In Market Plans, Small Group and Large Group Plans, a total of $76.9 million in rebates were unclaimed from 2012 – the first year the rebates were granted – through 2018 , according to Kaiser’s research. Unclaimed rebates are generally subject to individual state laws regarding unclaimed property.

“If you’ve moved, you may want to contact your insurer to find out if you qualify for a discount,” she said. “Insurers are supposed to make a good faith effort to locate you, but…some discounts are not claimed.”

Some workplace plan enrollees may also get a discount

In addition to the $603 million for enrollees in market plans, an additional $275 million is expected to go to those participating in plans through a small employer and $168 million to enrollees in large groups (excluding those of companies that self-insure), according to the estimate of the foundation. As with market enrollees, anyone who obtains insurance this way will not receive a discount.

The average discount per eligible member is $155 in a small group plan and $78 in large group plans. However, the reimbursement amount can vary greatly depending on your location and your insurer.

While some insurers send a check, others give you a credit on your premiums. Be aware that if you’re on a group plan, your company may split the reimbursement with you, Cox said. Simply put, it’s because you and your employer generally split the cost of insurance premiums.

Health insurers send rebates to meet ‘medical loss ratio’

So why are rebates paid?

Basically, insurance companies that sell group or individual policies must adhere to a “medical loss rate” requiring them to spend at least 80% of the premiums paid by policyholders on health care costs and certain other health-related expenses. patient health. (For large group plans, the ratio is 85/15.) If this threshold is not reached, participants are refunded the difference.

Each year, the ratio is calculated on the basis of a three-year moving average. So this year’s rebates come from insurance company financial data from 2019, 2020 and 2021 and will go to businesses and individuals who were enrolled in the plan in 2021.

The overall total of $1 billion in redemptions is down from the $2 billion issued in 2021 and the record $2.5 billion in 2020.

About Bradley J. Bridges

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