The Affordable Care Act (known to all as “ObamaCare”) contains an 80/20 rule. Your HMO must spend at least 80% of your premium on health care and health-related services, or they must refund the difference to you. Through something known as the Medical Loss Ratio, the average amount your health care provider spent on patient care is calculated for each state. If the average amount your HMO spent falls X% below the 80% target, then each policy covered by that HMO within your state will be reimbursed X% of their respective premiums.