Medical Loss Ratio (MLR) Tracker
MLR = Medical Costs / Premium Revenue ACA requires: 80% individual/small group, 85% large group
Why MLR Matters
- Higher MLR → insurer is paying more claims (good for enrollees, pressure on margins)
- Lower MLR → insurer retains more as profit/admin
- Post-COVID trend: MLR rising as utilization normalizes
Company MLR Comparison (FY2023 Actuals — update with 2024)
| Company | Commercial MLR | Medicare MLR | Medicaid MLR | Blended |
|---|---|---|---|---|
| UnitedHealth | ~82% | ~87% | ~88% | ~84% |
| Elevance | ~84% | ~88% | ~89% | ~86% |
| Cigna | ~81% | N/A | N/A | ~83% |
| Humana | N/A | ~89% | N/A | ~89% |
| Centene | N/A | ~87% | ~88% | ~88% |
Sources: SEC 10-K filings — verify and update per company reports
Key Trends to Monitor
- Medicare Advantage MLR pressure (CMS rate reductions 2024-2025)
- Medicaid redetermination impacts (post-COVID unwinding)
- GLP-1 drug cost escalation effect on commercial MLR
- Behavioral health parity enforcement costs