According to the Affordable Care Act, what is the required medical loss ratio for health plans?

Prepare for the HFMA Business of Health Care Test. Study with flashcards and multiple choice questions, each question offers hints and explanations to boost your confidence. Ace your exam!

The required medical loss ratio (MLR) for health plans under the Affordable Care Act is set at a minimum of 80% for individual and small group insurance plans, and 85% for large group plans. This means that insurance companies must spend at least 80% of premium dollars on medical care and health services rather than administrative costs and profit. The purpose of this regulation is to ensure that consumers receive value for their premium payments, focusing more on healthcare services than on administrative overhead. Therefore, the correct answer aligns with the standards set forth by the ACA, which specifies that health plans need to maintain medical loss ratios within the range of 80% to 85%.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy