Exclusive! District of Columbia: 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 the District of Columbia:

  • Large Group Market rebates are shockingly large given how small the DC population is...and it looks like this has been the case for some time: $25.7 million last year, $21.5 million this year. Huh.
  • Small Group Market rebates dropped from $844,000 to $237,000
  • DC's Individual Market has always been tiny, due both to the total population size as well as the fact that Medicaid covers people earning up to 210% FPL in DC. Five people will split $313 from "Optimum Choice, Inc." (those aren't typos).

I'm not expecting much in the way of Indy market MLR rebates next year either. CareFirst is getting close to the 80% threshold, but GHMSI is still close to 90%, and Kaiser Health Plan has been losing money in DC for at least three years running. Even their 20% rate hike in 2019 doesn't seem to be doing much. I'm not sure what's going on with Kaiser, but they're not likely to fall below 80% anytime soon:

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.