ERM News - A Review of the 2013 Health Insurance Landscape – How Does your Program Stack Up?

In a recent study completed by the Indianapolis office of Milliman, the authors provide unique insights about the recent past and future of healthcare insurance. Three distinct health insurance risk profiles of “individual”, “small group”, and “large group” programs are discussed. Does your program look like one of these models?

During the past several years under the guidelines of the Affordable Care Act (ACA), the Milliman authors describe that “health insurers have had to comply with minimum loss ratio requirements, more stringent rate reviews, removal of annual benefit limits, first-dollar coverage of preventive care, and other requirements. The insurer experience in 2013 reflects the third year insurers have been required to comply with federal minimum loss ratio requirements.” Their report is an interesting look at the highlights of health insurer financial results in 2013, with a particular focus on medical loss ratio percentages, expense structure and profitability from 2010 to 2013 from Medicare databases.

The key highlights from the study include:

• Insurer financial results from 2010 to 2013 have not been significantly impacted in the group insurance markets • Individual markets have sustained a 3.9% underwriting loss in 2013 versus prior years

• Underwriting margins have substantially decreased over the period in individual health insurance markets

• A substantially higher proportion of the individual health insurance markets are experiencing underwriting losses beginning in 2013

• Thus far in 2014, new insurers have entered the individual health insurance market through federal or state insurance exchanges

For more details, visit the Milliman site for a copy of the study >>

By Robert J. Blackburn, Managing Principal, Blackburn Group, Inc., contact him at This email address is being protected from spambots. You need JavaScript enabled to view it..