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Medicaid has approx a 3% overhead, wheras Insurance companies strive for an overhead of 15% OR MORE.
"Medical care ratio (MCR), also known as medical cost ratio or medical loss ratio, is a metric used in managed health care
to measure medical costs as a percentage of premium revenues.[1] It is calculated by dividing those premiums allocated for
fully insured or self-funded health care coverage into the total expenses for inpatient, professional (physicians and
other licensed providers), outpatient, and pharmacy. (Briefly, MCR = Costs/Premiums.) As a general rule, a medical cost
ratio of 85% or less is desirable. Some insurers now call MCR "benefit cost ratio" (BCR). In the United States, the term
is Medical Loss Ratio."
http://en.wikipedia.org/wiki/Medical_care_ratio
MLR Breakdown:
From "Insurance Company Health Plans Make More Money, Pay Less in
2005." Chicago Sun Times. Sept. 2006.
http://www.suntimes.com/business/73050,CST-FIN-health27.article
Whereas 10 years ago many plans had medical-cost ratios in the high
80s or 90s, now the highest percentage among large, publicly traded
health insurers is Health Net, at 83.9%. Aetna, which had a
medical-cost ratio well into the 90s when CEO John Rowe, MD, took over
in 2000, recorded a ratio of 76.9% in 2005, Dr. Rowe's final full year
before his retirement. That was the lowest medical-cost ratio for the
nation's largest publicly traded plans. Medical-cost ratios for 2005
(Source: Company 10-K, year-end filings with the Securities and
Exchange Commission):
* 76.9% - Aetna
* 82.3% - Cigna
* 83.9% - Health Net
* 83.2% - Humana
* 78.6% - UnitedHealth Group
* 80.6% - WellPoint
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