Health Plan Enrollment Trends

Mark Farrah Associates provides an excellent service of periodically releasing an analysis of trends for major health plans.  The most recent addresses the first quarter of 2013.   (MFA Brief)   Seven major plans–Aetna, Cigna, HCSC, Humana, Kaiser Permanente, UHG and Wellpoint–cover about 43% of the population.  Total membership for these plans increased by about 5.4 million to 136.7 million in the year from March 2012 to March 2013 to 136.7.  Over 80% of the gain was in self-insured business, which may reflect both employment gains at large companies and a shift to self-insurance as a tactic for dealing with reform.  Commercial risk enrollment actually declined by about 1.5 million people during this period, but was more than offset by increases in Medicare and Medicaid risk business.  Shifts in risk and self-insured enrollment likely affect profitability, as insured business is usually more lucrative.  Six of the seven major plans had enrollment increases during the primary open enrollment period from December 2012 to March 2013, with Wellpoint being the lone loser.  All the plans had year-over-year enrollment gains, but these numbers are affected by acquisitions.  Including acquisitions, Wellpoint had the largest percent gain.   UnitedHealth show the best balance between risk and self-funded growth.  UHG also has the largest enrollment at around 37 million, followed closely by Wellpoint at around 35 million.  Most plans had a profitability decline in the first quarter of 2013, probably partly due to reform requirements relating to MLR.  Overall, however, net margins are relatively stable for the plans over the last few years.  As we head into reform implementation, the brief portrays a picture of relative prosperity and stability for the large national health plans.