2022-03-28-奥纬咨询-Health_Insurer_Financial_Insights_Volume_8_18页_2mb

Health Insurer Financial Pulse June 2022 Summary

1 Market Overview

• Overall profit margins for health insurers decreased in 2021 to 1.8% from 4.0% in 2020, primarily due to increased loss ratios and utilization.
• All types of companies experienced margin declines in 2021: Public Companies (3.6%), Non-Public Blues (0.2%), and Other Health Carriers (-0.4%).

2 Q4 2021 Statutory Results By Market

2.1 Profit Margins

• All markets saw reduced profitability compared to 2020.
• Public Companies faced increased loss ratios and operating expense ratios.
• Non-Public Blues saw the largest margin decline, from 3.4% to 0.2%.

2.2 Premium Growth

• Group Market: Premiums increased by 3.0% (average $488 PMPM).
• Individual Market: Premiums decreased by 3.7% (average $530 PMPM).
• Medicare Advantage: Premiums rose by 2.5% in the fourth quarter.

2.3 Claim Ratio Trends

• Individual market claims ratio increased by 3.7% to 87.5% in 2021.
• Group market claims rose 5.0% to 88.3%, driven mainly by Non-Public Blues (+6.1%) and Other Health Carriers.

3 Individual MLR Rebate Trends

• The Three-Year Average MLR remained at 81.9% as of 2020.
• MLR rebates decreased from $1.7 billion (1.9% of premium) in 2020 to $1.3 billion (1.5% of premium) in 2021.

4 Q4 2021 Public Companies' Financial Performance

• Public insurers experienced declining margins due to increased loss ratios and operating expense ratios.
• Medical loss ratios (MLR) averaged 85.2% in 2021, the highest on record.
• UnitedHealthcare saw its margin drop from 4.9% to 3.4%, Anthem from 5.2% to 1.7%.

5 M&A And Market Capitalization Corner

• Minimal M&A activity in Q4 2021 and Q1 2022, with only $5.4 billion deal by UnitedHealth Group.
• Public companies significantly increased market capitalization: Health Plans grew by 83% from Q1 2019 to Q1 2022.

6 MLR Rebate And Income Trends

• In 2020, MLR rebates were $1.7 billion, down from higher amounts in previous years.
• Quality improvement expenses increased, contributing to higher MLRs in 2020.

7 Carrier Analysis

• Profitability declined across carriers during Q4 2021 due to seasonal factors and rising healthcare costs affecting utilization.

The report highlights declining profitability in the health insurance industry, constrained by rising healthcare costs and minimal M&A activity following major market growth.