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Affordable Care Act 2024 Medical Loss Ratio Rebates

August 11, 2025

What Is the Affordable Care Act’s Medical Loss Ratio?

The ACA’s MLR is the percentage of insurance premium dollars a health insurer spends on health care services and expenses reported as activities to improve health care quality. 

The ACA sets MLR standards for health insurers. For the 2024 MLR reporting year, ACA’s MLR standard for the large group market of a state is 85%. ACA’s MLR standard for the small group markets of a state is 80%. For individual markets, which includes  student health plans, insurers must meet a minimum MLR of 80%. 

If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may be required to provide MLR rebates in that market.

The ACA’s commercial MLR standards apply to certain Fully Insured health insurance coverages in the Group and Individual markets. These standards don't apply to ASO, Self-Insured group health plans, or Medicare and Medicaid. 

2024 ACA MLR Rebates

Upon further review, Blue Cross and Blue Shield of New Mexico has determined that there are no members in plans for which an MLR rebate is due for the 2024 reporting year. For more information, please read Key Questions About the ACA’s MLR.

Key Questions About the ACA’s MLR

Q. What is the ACA’s Medical Loss Ratio?
A. The ACA set MLR standards for health insurers. MLR is the percentage of premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.

For the 2024 MLR reporting year, the MLR standard for the New Mexico large group market is 85%. The MLR standard for the individual and small group markets in New Mexico is 80%

The ACA’s commercial MLR standards apply to certain fully insured health insurance coverages in the group and individual markets. They don't apply to self-insured group health plans or to Medicare and Medicaid.

If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.

Q. For purposes of the ACA’s MLR, what types of activities are considered to be quality improvement activities?
A. Among other things, activities to improve quality of care are designed to improve health outcomes for members. For example, these activities may include:

  • Enhance patient safety
  • Promote health and wellness
  • Improve transparency
  • Support meaningful use of health information technology, or
  • Prevent hospital readmissions

In general, these activities are aligned with criteria developed by professional medical associations, government agencies, accreditation bodies and other nationally recognized health care quality organizations.