UPDATE: Ambetter Health MLR Rebates for 2025 Policies

Some clients enrolled in a 2025 Ambetter Health Marketplace (on-exchange) or off-exchange plan may receive a rebate for a portion of their health insurance premiums. This rebate is required under the Affordable Care Act (ACA) through the Medical Loss Ratio (MLR) requirements.

What Agents Need to Know

Ambetter Health is required to provide these rebates by September 30, 2026.

• Current Ambetter Health members: The rebate will be applied to their monthly premium due on or after September 30, 2026.

• Former Ambetter Health members: Clients who are no longer Ambetter Health members will receive a rebate check.

• Rebate amounts: The amount and method of the rebate may vary based on state, family size, and/or amount of premium paid.

Important for Your Clients

The MLR rebate does not change a client's current:

• Premium

• Deductible

• Copay

Broker commissions are also not affected by the rebate.

What Is the MLR?

The ACA requires health insurance companies to issue a rebate when they do not spend at least 80% of the premiums they receive on healthcare costs and quality improvement activities. This requirement is known as the Medical Loss Ratio (MLR) or the 80/20 Rule. Some states set an MLR higher than 80%.

Resources

Ambetter Health has provided sample rebate letters and check notifications to help agents understand what their clients may receive.

Questions?

Contact Ambetter Health Broker Sales Support at 1-855-700-7985 or email [email protected].

Communication for broker internal use only. Not for client distribution.