10/16/2026
Compliance Spotlight
What Are Medical Loss Ratios (MLRs) — and Why Do They Matter?
Did you know that health insurance companies are required to spend a certain percentage of your premium dollars on healthcare?
Under the Affordable Care Act (ACA), Medical Loss Ratio (MLR) rules help ensure that insurance companies are using premium dollars for medical care and improving healthcare quality.
Here's how it works:
Individual & Small Group Plans: Insurers must generally spend at least 80% of premium dollars on healthcare and quality improvements.
Large Group Plans: Insurers must generally spend at least 85% on healthcare and quality improvements.
Do you have questions about MLR's?
Send us a message!