New York: 60,000 enrollees will receive...wait for it...$1.46 apiece! (oh, and NY's MLR hits at 82%)

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 New York:

Huh. Only one Individual Market carrier in New York State ended up having to pay out MLR rebates this year. Not only is it a company I've never even heard of before I started this project, but the amount is almost absurd: $87,000 being paid back to 60,000 enrollees...or an average rebate of $1.46 apiece.

There's no rebates at all in the Small Group market this year, but there's a decent $24 million being paid back to 390,000 Large Group plan enrollees.

Here's one interesting tidbit: Just as I discovered that the MLR threshold in Massachusetts is 88% for the Individual and Small Group markets, New York also has a higher MLR threshold than the ACA requires: 82%. This is the only reason "US Life Insurance Co. of NY" even had to pay back that much to indy plan enrollees.

I'd keep a close eye on Fidelis next year, however; they could end up having to pay back as much as $9.5 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.