Profit Margins Trend Downwards for Aggregate BCBS Plans in 3Q25

January 29, 2026

According to Mark Farrah Associates’ (MFA’s) Health Coverage Portal™, as of September 30, 2025, Blue Cross Blue Shield (BCBS, or Blues) membership comprised 37.2% of total U.S. health insurance (Individual plus Employer-based, for all funding types, Medicaid & Medicare) enrollment, or 119.1 million members. In this brief, MFA assesses year-to-date profit margins of BCBS plans, comparing year-over-year performance from September 2021 (3Q21) to September 2025 (3Q25), based on the National Association of Insurance Commissioners (NAIC) and the California Department of Managed Health Care (CA DMHC) statutory reporting.

The aggregate profit margins (net income divided by total revenues) for all (Total) Blues plans decreased from 3.9% as of 3Q21 to 3.1% in 3Q22. The aggregate profit margin rose slightly in 3Q23 to 3.5% before dropping to 2.1% in 3Q24. As of 3Q25, the downward trend continued, with combined profit margins for all Blues entities, including those not licensed by the Blue Cross Blue Shield Association, at 1.4%. The following graph illustrates this trend, along with the profit margins of the top five Blues entities: Elevance Health, Health Care Service Corporation (HCSC), Blue Cross Blue Shield of Michigan (BCBSMI), Highmark, and GuideWell Mutual Holding Group.

Leading BCBS Profit Margin Performance

The leading BCBS plans are based upon total members as of September 30, 2025. These plans have long been health insurance leaders across the country with diversified product portfolios, including commercial, Medicare and Medicaid business, and specialty benefits. Profit margins for the leading plans have had mixed results, due in part to portfolio differences. The most recent year-over-year profit margins, 3Q24 to 3Q25, for these top plans are illustrated below, in order of 3Q24 profitability.

• Elevance Health continued to report the largest profit margin for top Blues plans of 3.9% in 3Q25, a decrease from 4.6% in 3Q24. The company has experienced a slow decrease in profit margins since 3Q22.
• Highmark experienced a significant decrease in profit margins, dropping from 1.7% in 3Q24 to -1.3% in 3Q25. After seeing marginal growth in 3Q23, this is the second year in a row that Highmark reported a decline.
• GuideWell experienced a notable drop in profit margins between 3Q23 and 3Q24, from 2.7% to 1.6%. This trend for GuideWell continued through 3Q25, when the company had a profit margin of 0.4%.
• Health Care Service Corp (HCSC) reported a profit margin loss of -1.1% in 3Q25, a noticeable decrease from 1% in 3Q24, continuing its downward trajectory from 3Q21.
• BCBS of Michigan has seen fluctuating profit margins over the last few years, ending 3Q25 at -0.8%, a significant improvement from -3.5% in 3Q24.

Conclusion

Blues plans continue to gain new members, particularly in the Individual and government segments. Year-over-year, overall profitability was down through 3Q25 primarily due to the shift to lower-margin business lines. Of the leading Blues plans, only BCBS of Michigan saw increased profit margins, while the other top plans reported declines. With full annual results available in the spring, MFA will report on important BCBS plan performance and provide valuable health insurance insights in its future briefs.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health ^PLUS, and Health Plans USA™. For more information about these products, refer to the product pages and brochures, available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.

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