Exclusive! North Carolina: 2018 MLR Rebate Payments (& potential 2019 rebates)

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

  • First, I assumed total enrollment for each carrier remains exactly the same year over year.
  • Second, I assume the average 2019 rate changes I recorded for each carrier last fall are accurate.
  • Third, I assume 2019 is seeing a 5% medical trendline on average...that is, that total 2019 claims per enrollee will be 5% higher than 2018's.

All three of these are very questionable, of course, but they at least provide a baseline.

All that being said, here's what the payments for 2018 going out this months look like in North Carolina:

  • Large Group market rebates dropped over 90% from $770,000 to $70,000.
  • Small Group market rebates dropped from $2.9 million down to nothing
  • Individual market MLR rebates ballooned from just $650,000 to $9.8 million, with over 490,000 enrollees receiving around $20 apiece

For 2020, I expect individual market rebates to drop down to around $3.5 million. Blue Cross Blue Shield of North Carolina, which is dolingout the bulk of rebates this year, dropped their premiums by 4.1% this year. This, combined with an assumed 5% medical trend, should bump their 3-year rolling average up a bit more, resulting in them not having to make any payments, while Cigna will likely still have to pay out a few million:

AGAIN: There's absolutely no guarantee that things will play out this way. It's possible that none of these carriers will make MLR payments next year, or only some of them will, or the amounts will be smaller. These 2019 projections are pure speculation on my part based on a number of big assumptions.