The Missouri Department of Commerce and Insurance has issued a reminder about the Medical Loss Ratio (MLR) and Health Insurance Rate Review provisions under the Affordable Care Act (ACA). These rules require insurers to be transparent about how premium dollars are spent on medical care versus administrative costs such as underwriting, marketing, and executive salaries.
According to the Missouri Department of Commerce and Insurance, insurers must spend at least 80 percent of premiums in the individual and small group markets, and 85 percent in the large group market, on medical care and quality improvement. If insurers do not meet these thresholds, they are required by law to issue refunds to policyholders through rebate checks or premium credits by September 30 each year.
Insurers in Missouri must also submit rate filings that show how they set premiums and project future costs. The department reviews these filings to ensure premiums are reasonable, using MLR as one of the key measures.
Consumers can view MLR data and Missouri’s rate filings for 2026 through the CMS MLR Data Resources or the DCI Rate Filings Portal. These resources provide access to information about how premium dollars are used.
