With the ACA, health insurers have had to comply with minimum loss ratio requirements, more stringent rate reviews, removal of annual benefit limits, first-dollar coverage of preventive care, and other requirements. The insurer experience in 2013 reflects the third year insurers have been required to comply with federal minimum loss ratio requirements. This report provides an overview of health insurer financial results in 2013. It also provides an evaluation of the changes in the health insurance industry's expense structure and profitability from 2010 to 2013, including changes in the medical loss ratio percentage.