Mark Farrah Associates Assessed Health Insurance Segment Performance Trends

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- In the latest analysis brief, Mark Farrah Associates (MFA), www.markfarrah.com, assessed health insurance trends for enrollment, segment profitability and premiums from their analysis of the National Association of Insurance Commissioners' (NAIC) Supplemental Health Care Exhibit (SHCE). The brief included a focus on four year trend data in membership, claims incurred PMPM (per member per month), adjusted premium PMPM and SHCE- reported MLR for the Individual and Small Group comprehensive segment leaders. Health plans in these two segments face the added constraint of a standard (minimum) MLR (Medical Loss Ratio), a key component of the Risk Corridor program, one of three premium stabilization programs instituted by the Affordable Care Act (ACA) (see also Health Insurance).

With three full years of health insurance activity under the ACA, the law has had a significant impact on membership, premiums and medical costs. Commercial enrollment declined 8.6% (5.75 million members) to approximately 61 million since the onset of the ACA. Profitability across the commercial segments has also been negatively impacted with declines within the Small Group and Individual segments. However, after multiple years of premium increases, there was marginal improvement in profitability for 2016. Between 2015 and 2016, both the Small Group and Individual segments experienced improvements in underwriting gain/loss of 17% and 21%, respectively.

Based on adjusted premiums, the Individual segment leaders included UnitedHealth, Anthem, Health Care Service Corp (HCSC), Guidewell Mutual Holding Group and Aetna. Among these leaders, UnitedHealth's incurred medical claims PMPM experienced a 92% increase over the four year period, leading to a reported 70% increase in adjusted premium PMPM. In contrast, Aetna saw the lowest overall increase in incurred medical claims PMPM, and consequently reported the lowest increase in adjusted premium PMPM.

For the Small Group segment leaders, United Health, Health Care Service Corp (HCSC), Anthem, Aetna and Humana experienced mixed results over the four year period. Aetna saw a large increase in incurred medical claims PMPM leading to a 39% increase in adjusted premiums PMPM since 2013. Humana, facing less claims cost pressure in this segment, increased premium PMPM by just 5.5 percent.

To read the full text of "An Analysis of Individual and Small Group Health Insurance Trends", visit the Analysis Briefs library on Mark Farrah Associates' website. About Mark Farrah Associates (MFA) MFA is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Committed to simplifying analysis of health insurance business, products include Medicare Business Online™, Medicare Benefits Analyzer™, Health Coverage Portal™, County Health Coverage™, and Health Plans USA™. View source version on businesswire.com: http://www.businesswire.com/news/home/20170609005050/en/