Insurance companies sell health insurance plans that provide coverage for medical costs. If you know the company you want to get health insurance coverage with, you can shop for and enroll in plans on their online portal or directly over the phone.
What is a Medical Loss Ratio?
The ACA requires health insurers in the individual and small group markets to spend at least 80 percent of the premiums they receive on health care services and activities to improve health care quality. This is referred to as the Medical Loss Ratio(MLR) rule or the 80/20 rule.
If a health insurer does not spend at least 80 percent of the premiums it receives on health care services and activities to improve health care quality, the insurer must rebate the difference.
For more information: https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio
2026 QHP issuers MLR:
| Medical Loss Ratio | Issuer |
| 91% | Alliant |
| 80% | Ambetter |
| 93% | Anthem (AMGP) |
| 80% | Anthem (BCBS) |
| 84% | CareSource |
| 99% | Cigna HealthCare |
| 106% | Kaiser |
| 85% | Oscar |
| 85% | UnitedHealthcare |
How are plan names structured?
All issuers must offer plans and plan variations with marketing names that include correct information, without omission of material fact, and do not include content that is misleading.
Plan names follow the format:
- Metal Level (bronze, silver, gold, platinum)
- Product Type (HMO, PPO, EPO)
- Individual Deductible Amount
- Primary Care Copayment or Coinsurance Amount
Plan names may also include a marketing name and specialty services or benefits.
Example:
List of available insurance companies
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