MEDIGAP Medical Loss Ratio

GailL1 — Sat, 23 May 2026 03:14:29 GMT

The NAIC (National Association of Insurance Commissioners) does a report on Medigap plans, I believe yearly - this is the last one Issued that I found - 2024, issued in 2025.

NAIC - NAIC NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS 2024 Medicare Supplement Loss Ratios

For Medigap (Medicare Supplement) plans, a higher Medical Loss Ratio (MLR) means a larger percentage of your premium dollars is going directly toward paying medical claims rather than into the insurer's administrative costs or profits

This came from page 5 - a TEN Year Summary Comparison of all plans - 85% is what is legislated for ACA plans to pay out in coverage or they have to send a premium refund. Of course, there is no such rule for Medigap plans and since this private gap (financial protection) insurance then they have tried to keep the MLR close to 75% or lower to maximize their profits (after their administrative cost has been covered)

But now they are paying out more and more in (medical) benefits compared to the premiums they have received. So the increase was due and they probably had no problem getting it approved by the state insurance commissioner in your state.

Of course the actual increases are by insurers - but if you want to digest more of this long report you will see that some plans are really paying out the benefits in comparison to the premiums they are reaping.

topic MEDIGAP Medical Loss Ratio in Medicare & Insurance

MEDIGAP Medical Loss Ratio