If you or your parents have a Medicare Advantage plan, the insurer that runs it files a yearly report with the federal government. The report shows, plan by plan, how many dollars came in and how many went back out as medical care for the people enrolled. The floor is 85 percent. An insurer that spends less than that on care has to send money back to Medicare, and can be blocked from enrolling anyone new.
Those reports are public. Almost nobody reads them.
I am reading them.
I am a licensed New York insurance agent and an investigative reporter, and for months I have been watching what is happening to Medicare choices from inside the system and in the federal data. This series will follow the money: what insurers collect, what they pay out for care, what they keep, and who is left with fewer options while the dollars move.
The opening question is simple. When choices shrink for the people using Medicare, who benefits?
Along the way, you will learn how to look up the numbers for your own plan, because those files belong to the public. That includes you.
The first piece is in the works. It will be worth the wait.
Heidi Macomber, Mammawrites
Sources: Centers for Medicare and Medicaid Services, Medical Loss Ratio program page, cms.gov/medicare/health-drug-plans/medical-loss-ratio (accessed October 20, 2026); Social Security Act section 1857(e), as amended by the Affordable Care Act of 2010; Code of Federal Regulations, Title 42, sections 422.2410 and 423.2410 (85 percent minimum medical loss ratio and sanctions); CMS Medical Loss Ratio Public Use File, contract year 2023 (public release).