Sep 23, 2021
High health insurance premiums can really strain a family’s budget, and it stings even worse once you know how much of your money isn’t spent on medical care.
Between 25 and 33 cents of every dollar spent on health care in the U.S. goes to administrative costs like billing and marketing.
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Fortunately, the federal government is trying to force health insurance companies to be more efficient, making them issue rebates when they don’t spend enough on care.
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If your health insurance company has been charging too much, you could receive a check for hundreds of dollars by the end of the month.
Why are insurance companies sending checks?
While insurers collect the same amount in premiums every month, how much they spend will vary based on the claims that are submitted.
To ensure health insurers don’t pocket the extra cash or splurge on marketing, the Affordable Care Act enforces “medical loss ratio” requirements.
For individual, family and small group plans, insurance providers have to spend 80% of their premiums on claims and other activities of value to policyholders. Those activities can include:
- Health assessments, wellness coaching and other programs to help individuals manage their health conditions.
- Activities designed to reduce medical errors and improve patient safety.
- Hospital discharge plans to reduce the need for hospital readmissions.
A maximum of 20% can go to overhead. This is known as the 80/20 rule — though for large group plans with 50 employees or more, the ratio is 85/15.
If insurance providers don’t meet that requirement, they have to issue annual rebates to plan participants in the form of a premium credit or check.
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Many people will get hundreds of dollars
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Last year, insurers ended up owing a record $2.5 billion in rebates. This year’s toal is expected to be the second-highest: $2.1 billion owed to about 10.7 million Americans, according to estimates by the nonprofit Kaiser Family Foundation.
The rebates are based on a three-year average, and the last few years have seen insurers enjoy hefty profits. Claims were especially low during the pandemic as doctors and hospitals cancelled elective procedures and patients skipped routine care.
While the amount people receive will vary by region and plan, the big money is going to people insured in the individual market. About 5 million consumers will share a total of $1.52 billion, averaging about $300 per person.
In the small group market, the average rebate should be about $125 per person. And in the large group market, $95 per person.
Your state can make a huge difference, too. Look at 2019 — in Kansas, the average eligible policyholder got back $1,359, while Delaware’s average was zero.
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A few other factors can affect your payout. If you get your coverage through your employer, your rebate may be split between you and your company. And if the refund is small — $5 for individual plans and $20 for group plans — the insurer isn’t required to pay up since the effort may cost more than the rebate itself.
How to find out if you’re getting a refund
Carriers are required to pay out these rebates by Sept. 30, which means some consumers may have already received a check in the mail, direct deposit or a credit to their account.
If you haven’t heard from your insurer, you can check whether you qualify for a rebate using the MLR Search Tool from the Centers for Medicare & Medicaid Services.
The tool will let you see whether your provider met the minimum “medical loss ratio” requirements. If they didn’t, you’re due a rebate and you’ll want to get in touch.
Other ways to cut your monthly bills
Even if you do have a couple hundred bucks on the way, the average American policyholder spends thousands on health insurance every year. Fortunately, you have a few options to free up significantly more cash.
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Find a cheaper health insurance policy. The Insurance Information Institute recommends comparing at least three quotes to ensure you’re not overpaying for your coverage. That’s easy enough to do using a quote comparison site — all you’ll have to do is answer a few questions and then review your options.
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Slash your other insurance bills. The same strategy applies to your other policies. Switching to a different auto insurance company could reduce your premiums by up to $1,000 a year. And you could trim a similar amount from your homeowners insurance bill.
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Cut the cost of homeownership. If you’re a homeowner and haven't refinanced during the past year of ultra-low interest rates, you could be missing out. You could save hundreds of dollars per month and thousands over time.
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Dominate your debt. Credit cards have been a life-saver for many Americans during the pandemic, but their high interest can wreck your finances for years. Rolling your balances into a lower-interest debt consolidation loan will help you pay off your debts more quickly and affordably.
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Get serious about saving. If your budget is stretched to the point of snapping, put a stop to any needless spending. Whenever you shop online, use a free browser add-on that automatically hunts for better prices and coupons so you’re not paying more than you have to.
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Sigrid is a deputy editor on the Moneywise team, where she has also worked in a number of editing and reporting roles. She has 5 years experience writing about personal finance and takes great pride in demystifying complex financial issues and finding the personal in personal finance topics.
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