Roughly three-quarters of health insurers spent enough money on medical care to avoid paying refunds to their customers in 2011 and 2012, according to a report (PDF) issued by the U.S. Government Accountability Office. Insurers operating in the individual, small group and large group markets spent a median of 88% on medical care during those two years.
Under the Patient Protection and Affordable Care Act, insurers are generally required to maintain medical-loss ratios of at least 80% for the individual and small group markets, and 85% for the large group market. Health plans that fail to spend enough money on medical care are required to refund money to their customers. (A small group is typically defined as an employer with fewer than 50 employees.)