Pennsylvania: Holy Crap.

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 Pennsylvania:

What makes Pennsylvania's MLR rebate numbers for 2018 so astonishing isn't the total dollar amounts, although those are certainly eyebrow-raising (over $69 million on the Individual Market alone, plus another $22 million for Small Group enrollees and $38.5 million for Large Groups). No, what's truly staggering is the average rebate amount per person on the Indy Market: 67,000 enrollees should receive checks averaging over $1,000 apiece.

But I can still take that one step further: Look at the per-person average for HMO of Northeastern Pennsylvania, otherwise known as First Priority Health HMO (this is not the same as First Priority Life Insurance, although that's another division of the same parent company). According to their filing with CMS, 12,308 enrollees will receiving nearly $34 million in rebate payments...averaging $2,751 apiece. You read that right.

Remember, that's the average. For older enrollees (say, 50-64), this could potentially be much higher...I could see some people getting windfalls of $5,000 per person or more. Astonishing.

In 2020, I could even see the potential Indy Market MLR rebates nearly double to as much as $124 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.