Health insurers will pay $1 billion in rebates to 8.2 million people this year

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Your health insurance company may owe you money.

Depending on how you get your coverage, you could be one of 8.2 million policyholders set to receive $1 billion in premium discounts this fall from various insurers, according to preliminary analysis by the Kaiser Family. Foundation.

The amount is down from the $2 billion issued in 2021 and the record $2.5 billion in 2020.

“Over the past two years, we’ve seen some very significant discounts — twice as much as this year’s amount,” said Cynthia Cox, the foundation’s vice president and director of its Affordable Care Act program. “But I would say a billion dollars is still significant.”

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Generally, you’re more likely to see a discount if you have an individual policy (including through a state or federal health exchange) or participate in a small or large group plan. (Many of America’s largest employers choose to self-insure, which means their plans don’t have to meet certain requirements imposed on insurance companies. Different rules also apply to Medicare and Medicaid coverage.)

So why are rebates paid?

Basically, insurance companies that sell group or individual policies must adhere to a “medical loss rate” requiring them to spend at least 80% of the premiums paid by policyholders on health care costs and certain other health-related expenses. patient health. (For large group plans, the ratio is 85/15.) If this threshold is not reached, participants are refunded the difference.

Each year, the ratio is calculated on the basis of a three-year moving average. So, this year’s discounts come from insurance company financial data from 2019, 2020 and 2021.

This year’s refunds – which will go to eligible participants enrolled last year – are approximately $141 per plan participant in the individual market, $155 in the small group market and $78 in the large group plans. , according to Kaiser’s analysis. However, this amount can vary greatly depending on your location and your insurer.

Insurers usually send a check to policyholders or deduct the premium discount (and send a check to people who are no longer registered but owe money). Be aware that if you’re in a group plan, your employer may split the reimbursement with you, Cox said.

If you qualify for a discount, you should receive it by September 30.

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