One of Ambetter’s competitors, United Healthcare, is also making rebates to Missouri customers. The rebates from Ambetter are also more than all rebates from all companies operating in the Missouri marketplace since the Affordable Care Act began requiring them in 2012. Over 12 years, insurers have rebated $587.1 million to Missouri policyholders, with the most being $192.7 million in 2019. Each insurer must spend 80% of total premiums — and 85% of money from premium increases — on health care. Ambetter covers about 46% of the 270,275 people buying individual plans.