Health Insurer Enrollment Trends

Mark Farrah Associates released an analysis of large health plan company results to date for 2011.  The analysis covers Aetna, Wellpoint, UnitedHealth Group, Humana, Kaiser, Cigna and Health Care Service Corporation, which together cover about 50% of the insured population.  (MFA Release)   Collectively these plans have enrollment of about 128 million people, up from about 126 million at the end of 2010.  Overall they added about 337,000 seniors, 272,000 Medicaid members and 1,428,000 commercial enrollees.  In the commercial segment, self-insured, or administrative services only, business accounted for all of the growth, or 2,645,000 members in this time period, while fully-insured lives actually shrunk by 609,000 people.  On a full year-over-year basis, however, fully-insured business did show growth of about 416,000 members.

UnitedHealth Group accounted for the biggest chunk of this growth, adding 1.2 million enrollees, with largest subset being self-insured commercial members.  For the full year from Q2 to Q2, Aetna and Cigna appear to have lost enrollment, while UnitedHealth, Kaiser and Wellpoint had gains.  Cigna lost about 100,000 Medicare members in the first half of this year, which may help explain the recent acquisition of HealthSpring.  Most plans also saw profitability improve, largely due to lower medical cost trends, which is probably attributable to continued growth in high-deductible, high copay plans.  Interestingly, Kaiser, which is nominally non-profit, appears to have pretty high net margins.  The increasing movement to self-insurance may reflect employers’ belief that they will have more flexibility if they are self-insured when the reform law kicks in more fully in 2014.