Mark Farrah Associates Reported Improved Health Insurance Segment Profitability

June 29, 2018

McMurray, Pennsylvania--(Business Wire) – Mark Farrah Associates (MFA),, examined trends in membership, claims incurred PMPM (per member per month), adjusted premium PMPM and MLR (Medical Loss Ratio) for the Individual and Small Group comprehensive segment leaders.  Assessing segment membership and profitability changes over time has provided insights on the impact and direction of the Affordable Care Act (ACA) since December 2013.  Based on their analysis of the National Association of Insurance Commissioners’ (NAIC) Supplemental Health Care Exhibit (SHCE), MFA reported the industry began to see improvements in profitability for 2016 and 2017, especially in the Individual comprehensive medical market.

Since the onset of the ACA, total commercial enrollment declined 11.8% (7.94 million members) to approximately 59 million.  Profitability across commercial segments has also been negatively impacted especially in the Small Group and Individual markets.  However, in 2017 and despite declines in enrollment, underwriting gain in the Small Group segment more than doubled since 2016 and is now higher than the pre-ACA mark of $2.148 billion.  In addition, the Individual segment experienced an aggregate underwriting gain of $1.7 billion, the first reported gain since segment reporting began in 2010.

Based on membership, the Individual segment leaders in 2017 included Anthem, Health Care Service Corp (HCSC), GuideWell Mutual Holding Group, Centene and Molina.  2017 marks the first year Centene and Molina have been counted among the segment leaders, displacing UnitedHealth and Aetna.  Of the segment leaders, Molina was the only plan reporting a net underwriting loss for 2017.  The Small Group segment leaders were United Health, Health Care Service Corp (HCSC), Anthem, Humana and Aetna.  All of the top 5 companies experienced further losses in membership in 2017.  Their membership dropped an additional 9.2% in 2017 and is down over 1.5 million members since 2014.  However, increases in claims costs have been manageable and premium increases have led to improved profitability. 

To read the full text of "Improved Profitability for the Individual and Small Group Health Insurance Markets for 2017", 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™.

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