Trends in Profit Margins for Leading Blue Cross Blue Shield Plans

January 30, 2023

According to Mark Farrah Associates’ (MFAs) Health Coverage Portal™, as of September 30, 2022, Blue Cross Blue Shield (BCBS or Blues) membership comprised 38% of total U.S. health insurance (Individual plus Employer-based, for all funding types, Medicaid and Medicare) enrollment, or nearly 119 million members. BCBS plans with over $17 billion in revenue through the third quarter of 2022 (3Q22) include: Elevance Health (formerly Anthem), Health Care Service Corp. (HCSC), Independence Blue Cross, Blue Shield of CA, and Guidewell Mutual Holding Group. BCBS plans have been health insurance leaders for decades across the U.S. with diversified product portfolios, including commercial, Medicare and Medicaid business, along with specialty benefits.

In this brief, Mark Farrah Associates (MFA) assesses profit margins of the top BCBS plans, comparing year-over-year performance from September 2019 to September 2022, based on the National Association of Insurance Commissioners (NAIC) and the California Department of Managed Health Care (CA DMHC) statutory reporting. Total profit margins for Blues plans (net income divided by total revenues) increased from 5.8% as of 3Q19 to 6.1% in 3Q20. However, the total profit margin fell to 3.9% through 3Q21, and has continued to decline to 3% for 3Q22.

• Elevance Health (formerly Anthem Inc.) reported the largest profit margin for top Blues plans of 5.4% in 3Q22. The company experienced a profit margin decline of 1.2 percentage points between 3Q19 and 3Q20, but saw an increase in 3Q21, and again in 3Q22.
• Health Care Service Corp (HCSC) reported a profit margin of 4.6% in 3Q22, a slight decrease from 3Q21. The combined corporation reported the largest profit margin for top Blues plans of 13.8% in 3Q20. This was due to the recognition of the net premium impact of the recovered risk corridor payment, an amount totaling over $1.8 billion (over 5% of total revenue), as premium for the nine months ended September 30, 2020. HCSC had not previously accrued any amounts, regarding its lawsuit in the U.S. Federal Court of Claims against the U.S. Department of Health and Human Services (HHS) and CMS, due the Corporation for the 2014 -2016 benefit years.
• Independence Blue Cross Group, with 54% of its enrollment through Medicaid plans in eight states, experienced slight increases in profit margin from 3Q19 to 3Q21 but decreased to 0.9% in 3Q22.
• Guidewell Mutual Holding Group increased its profit margin from 1.9% in 3Q21 to 2.7% in 3Q22, but a significant drop from 7.7% in 3Q19.
• Blue Shield of CA had a profit margin of -2.1% for 3Q22, a notable decline from 2.4% in 3Q21.
   

In Conclusion

While Blues plans remain financially strong and continue to gain new members, year-over-year, overall profitability was down through 3Q22. Of the leading Blues plans, only Guidewell and Elevance Health reported improved profit margins. Delving deeper into administrative and medical cost trends, data that is available in MFA’s Health Coverage Portal show increased spending on hospital and medical expense and administrative expenses are driving the declines in profitability for the Blues. Full annual results will not be available until spring. As always, Mark Farrah Associates 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 informational videos and brochures, available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.

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