Oklahoma: $16 million in MLR rebates to be paid to 273,000 Blue Cross enrollees; next year could see a MASSIVE rebate increase

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 Oklahoma:

273,000 Blue Cross Blue Shield of Oklahoma enrollees will receive $16 million in MLR rebates this year...about half of them are on the Individual market, the other half in small group plans, although the group rebates are four times larger.

NEXT year, however, there could potentially be a massive Indy Market rebate...again, courtesy of Blue Cross Blue Shield of OK. They ran a horrible 100.6% MLR in 2016, but that's dropping off the formula next year, so they'll be looking at 2017's disturbingly low 69.2% and 2018's still-low 75.9%. With only a 2% average rate drop for 2019, their 3-year rolling average could come in at under 76%, which would result in up to a whopping $45 million in rebates being paid out to enrollees.



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.