One is that, because insurers set premiums well in advance of the actual plan year, they can guess wrong, either over- or underestimating demand or costs for care. For example, insurers set their 2020 premiums during the summer of 2019, when no one knew the covid pandemic would strike months later. Then, instead of increasing medical costs, the pandemic led many enrollees to avoid seeing the doctor or going to the hospital. So, that year’s premiums were wildly out of line with spending.
The Affordable Care Act’s first rebate checks were issued in 2012, when about $1.1 billion was distributed. That annual total dropped for a few years as insurers got better at estimating costs and setting premiums, but it has varied, with big spikes during the pandemic.People who gets health coverage through their jobs are unlikely to see a direct rebate.
Last year, about 6.2 million consumers nationally, 2.4 million in individual plans and the rest in a group or employer plan,, according to Norris’ analysis of government data. Although that’s a sizeable number of people, it’s still a small percentage of the more than 170 million who have job-based or Affordable Care Act coverage.
Norris said many insurers approached those spending limits even before the Affordable Care Act but that the law better defines the parameters, reins in spending on nonmedical costs and allows for rebates. Overall, that can benefit"anyone in a commercial health plan, regardless of whether they are getting a check or not," she said.