Top Insurers’ Financial Metrics and Membership Mix

March 16, 2023

The top five health insurers, based on comprehensive medical enrollment at year-end 2021, covered 131.1 million people, roughly 43% of the people insured in the United States. These top insurers − UnitedHealth, Elevance Inc., CVS Health, Centene and Health Care Service Corp. (HCSC) − offer products through three primary markets: Commercial, which consists of individuals purchasing insurance privately, through federal and state exchanges, or through employers; Managed Medicare, often known as Medicare Advantage; and Managed Medicaid programs.

They also offer other types of coverage, including Medicare Supplement, stand-alone prescription drug plans, dental, vision and additional product options. Understanding the market mix differences is useful for those looking to do business with health plans. Mark Farrah Associates’ Health Plans USA™, that was used for this analysis, is a valuable tool for comparing market mix, market share and other information about health plans, nationwide, and includes company contacts. 

• Combined, 39% of these top carriers’ total enrollment is from the commercial market, and 21% from Medicare and Medicaid combined.
• The remaining 623 health insurers have 15% of their business from Medicare and Medicaid products.
• UnitedHealthcare, the health insurance market leader, has 34% of its health insurance business through commercial plans, while 48% of its enrollment is from other products.
• Elevance (formerly Anthem), the second largest health insurance carrier, has more than 51% of its enrollment through commercial business, while only 28% is coming from other products.
• Centene has higher revenue than CVS Health and HCSC.’s. Around 51% of Centene’s business is through state Medicaid programs.
   

Market mix influences revenue, medical and administrative expenses, and other financial metrics, such as medical loss ratios (medical expense divided by premiums) and administrative expense ratios (administrative expenses divided by revenue), which can be derived from data in Health Plans USA.

Health Plans USA™ is a practical, low-cost tool for companies looking for a nationwide overview of the health insurance industry, including market share and general financial data for health plans, nationwide. This online database gives you access to annual enrollment, revenue and expenses for Commercial Risk, ASO, Medicare and Medicaid plans. It includes company contact information for sales and marketing outreach, company snapshots offering a quick review of each health plan, and a user-friendly web table design with easy-to-navigate tables and download to Excel capability. Annual 2022 data will be available in April of 2023.

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 informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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