Ambetter to Rebate $1 Billion to Missouri Policyholders Over ACA Compliance

Missouri's largest individual health insurer, Ambetter from Home State Health, a Clayton-based Centene Corporation subsidiary, is issuing over $1 billion in rebate checks to policyholders due to failing to meet the Affordable Care Act's Medical Loss Ratio (MLR) requirements.

These rebates exceed the total amount rebated by all insurers in Missouri since 2012 and also surpass recent national rebates from other companies such as United Healthcare. CMS evaluates insurers annually on how much of their premium revenue is spent on patient care versus administration, requiring an 80% minimum spend on care for total premiums and 85% for premium increases reliability.

Ambetter spent only 71.4% of premiums on care between 2022 and 2024, triggering this historic rebate. Ambetter holds approximately 46% of Missouri's individual market, followed by Elevance and United Healthcare. Despite the massive rebates, Ambetter proposes one of the lowest premium increases for 2024 at 1.9%, contrasting with much higher rate increase proposals from other insurers in Missouri. The Missouri Department of Commerce and Insurance anticipates individual market premium rises and changes to plan networks ahead of the final rate announcement by October 31. This rebate event highlights regulatory enforcement on insurer spending practices and market dynamics within Missouri's individual health insurance landscape, with potential implications for premium setting and consumer costs in the coming year.