How to Get a Health Insurance MLR Rebate You Are Owed

A letter came in August saying your health insurer spent too little of last year's premiums on care and owes you a rebate, or a coworker got one and you did not. The wrong assumption is that the rebate is a bonus the insurer chooses to send. It is a debt with a fixed due date, and for a workplace plan it goes to the employer first. These steps cover rebates on 2025 premiums, due by September 30, 2026.

Confirm your insurer owes a rebate for 2025

HealthCare.gov's page on rate review and the 80/20 rule says an insurer that does not spend at least 80 percent of premiums (85 percent for large employer plans) on care and quality improvement must return the difference. Open the CMS page of Medical Loss Ratio data and system resources and download the newest List of Health Insurers Owing Refunds PDF. The reporting year 2024 list was posted on September 12, 2025, and the 2025 list appears on the same page once CMS posts it. Find your state and the company name on your insurance card, and note the market column: individual, small group, or large group. For scale, the 2024 rebates by state file shows about $1.64 billion owed to 8.6 million people, an average of $192 each.

Check the mail for the August 1 notice

The HealthCare.gov page says the insurer must notify you, or your employer, by August 1 if a rebate is coming. If you buy your own plan and got nothing, the mailing may have gone to an old address or only to the policyholder on a family plan. The regulation, 45 CFR 158.240, says the rebate belongs to whoever paid the premium during the reporting year, so a plan you left during 2025 still owes you a share.

Know what the payment looks like

The HealthCare.gov page lists the three forms an individual rebate can take: a check in the mail, a lump sum deposit to the account that paid the premium, or a reduction in a future premium bill. The premium credit is the one people miss, so compare October's bill against September's before deciding nothing arrived. The regulation says the insurer must provide the rebate no later than September 30 following the reporting year, so a 2025 rebate is late on October 1, 2026.

Ask your employer for the employee share of a group rebate

For small and large group plans the rebate is usually paid to the employer. The employer cannot keep the part employees paid for. The Department of Labor's Technical Release 2011-04 says the portion attributable to employee contributions is a plan asset, allocated in proportion to what employees paid, and that the employer may pass it on as a premium reduction, a cash refund, or a benefit enhancement, within three months of receipt to stay clear of trust and reporting obligations. Email HR or the benefits administrator with the insurer's name, the market from the CMS list, and a request for the date the rebate was received and how the employee share is being distributed.

Escalate if nothing arrives after September 30

Call the member services number on your card and ask for the rebate status and the payment method on file. If the insurer says no rebate is owed but the CMS list names it in your state and market, or the payment went to a closed account, complain to your state insurance department, which enforces the rule the CMS Medical Loss Ratio page describes. For an employer that will not answer about the employee share, the Department of Labor's Employee Benefits Security Administration, which issued the Technical Release above, handles questions about plan assets.

If the amount is tiny. The regulation refers to a de minimis threshold, so an insurer may hold back a rebate of a few dollars per subscriber.

Sources. Rate review and the 80/20 rule, Medical Loss Ratio data and system resources, MLR Refunds by State and Market for 2024, List of Health Insurers Owing Refunds for 2024, 45 CFR 158.240, DOL Technical Release 2011-04, CMS Medical Loss Ratio.