Posts Tagged ‘Massachusetts health insurance’

Massachusetts Consumers Receive 2nd Highest Health Insurance Refunds in the U.S.

Thursday, July 24th, 2014

You could be one of the millions of Americans getting a refund from your health insurance company soon.  The Affordable Care Act has a law called the 80/20 rule, where insurance companies have to spend at least 80% of total premium costs on medical care or improving the quality of health care for consumers.  In The Boston Globe’s “Health Insurance Companies Refund $15B to Mass. Consumers,” Chelsea Rice talks about the refunds going out and the companies who will be paying them.  The U.S. Department of Health & Human Services released this data showing that Massachusetts consumers will be getting the second highest amount of refunds in the United States.  The total refund amount for the U.S. is $332 million, which will pay around $80 a family those those receiving refunds.  Florida health insurance companies will be paying the most refunds with $41.5 million owed.  Massachusetts residents will be paid out $15 million, which amounts to $133 per family getting a refund.

Almost all of Massachusetts’ residents have health insurance, most through their employer, but 1/4 of them still struggle with the burden of high health insurance costs.  The ACA’s 80/20 rule brings transparency and competition to the health insurance marketplace.  It also offers greater value to consumers in their health insurance plans.  Large group plans have to follow an 80/15 rule.  Insurance companies operate more efficiently when they are following this rule by cutting out unnecessary expenses.  They have been able to lower premiums throughout the U.S. by $3.8 billion.  Companies who do not follow the 80/20 rule during their fiscal year have to refund the excess they spent to consumers in their health insurance plan.  Those receiving refunds will get them by August 1 either by check, a discount in next years premium, an account reimbursement or a direct reimbursement through their company.

In Massachusetts, more than 208,000 consumers will be receiving an average refund of $133 per family.  This new 80/20 rule has made quite a shift in the amount of upfront value that consumers receive from their health insurance plans.  The biggest shift by far has been in the individual health insurance market.  Back in 2011, the HHS found that 61% of consumers in the individual market received upfront value from their plans.  Just two years later, 81% of people are receiving upfront value from their individual health insurance plans.  Ten health insurance companies in Massachusetts will be sending out refunds, including Fallon Community Health Plan, Neighborhood Health Plan Inc. and Tufts Associated HMO.  If you are one of the Americans receiving a refund from your health insurance company, look for that in the next week.