Medicare Advantage Medical Loss Ratio (MLR) Fact Sheet

Medical Loss Ratio (MLR) is the proportion of premium revenues that a health insurer spends on medical care and quality improvement activities in contrast to administrative activities and profit.

With the COVID-19 pandemic resulting in lower than expected utilization of care, BMA recommends that Congress act to modify the MLR requirements in response to the public health emergency by eliminating the year 2020 from the three-year enrollment penalty and the five-year date contracting penalty.