Medical Loss Ratio


How Your Health Care Dollar is Spent

Here’s how the non-profit Blue Shield of California says it spends each health care premium dollar it receives:

(Image: Blue Shield)

(Image: Blue Shield)

What’s significant here is that Blue Shield says it’s spending 85 percent of your dollar on medical care. This is right in line with a requirement of health care reform which has already gone into effect, the “medical loss ratio.” The MLR requires large employer plans to spend 85 percent of revenue on patient care. If they spend less, they must issue a refund to members. Blue Shield also has capped its income (i.e. profit) at two percent. It has pledged to return any income above two percent to its members.