Seven large health plan companies–Aetna, Cigna, HCSC, Humana, Kaiser, UnitedHealth and WellPoint–insure or administer coverage for 55% of the people with insurance in the US. (MFA Report) Mark Farrah Associates issues regular reports on enrollment trends and profitability for this set of plans. From September 2012 to September 2013 total membership increased from 132.2 million to 143.7 million, but much of this gain came from acquisitions. Without these one-time gains, growth was 2%. UnitedHealth added almost 3 million people from a TriCare contract and Aetna acquired Coventry and WellPoint acquired Amerigroup, accounting for most of the membership increases. UnitedHealth, the largest company, added an additional one million members beyond the TriCare contract. Wellpoint had no net growth beyond the Amerigroup acquisition. Aetna gained only a small number of members beyond its Coventry purchase. Most plans experienced a decline in profitability for the first nine months of 2013. UnitedHealth had lower net margins, while WellPoint and Aetna had slightly higher ones. The authors note several trends across these health plans, including international growth and focus as the US market stagnates and reform makes business less profitable; focus on managed Medicaid, due to the reform expansion of that business; use of private exchanges, managing loss ratios with more value-based provider contracts; and using technology to attract and retain consumers.
