Montana 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 month look like in Montana:

For 2019, there's not much going on here--no Individual or Small Group market rebates, and only a half a million for a few thousand Large Group enrollees.

I'd strongly recommend keeping an eye on HCSC (Blue Cross of Montana) next year, however...the only thing keeping them above the 80% threshold was their absurdly bad 106% MLR in 2016. Once that drops off the equation, they'll be looking at the 74.4% in 2017 and a mere 65.3% for 2018...and even with 2019 rates flat year over year, that will likely only nudge up to perhaps 69% for 2019. I wouldn't be surprised to see them having to lay out $14 million next year:

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.