2023 State-Level Accident and Health Insurance Data for the Broader Insurance Industry

September 19, 2024

A new source of state-level Accident and Health (A&H) insurance data became available last year and is available in Mark Farrah Associates’ (MFA’s) Health Coverage Portal™. The A&H insurance market is vast, and the revised Accident and Health Policy Experience Exhibit (AHPEE) as part of the National Association of Insurance Commissioners (NAIC) annual financial statements allows insurers to analyze and benchmark premiums, claims, lives, member months, and number of policies for multiple accident and health insurance segments nationally and by state. Historically, this information was only available based on the domicile of the insurer. In 2021, the AHPEE was modified to provide state insurance regulators with additional data and improve consistency across the annual financial statements.[1] In 2022, all types of insurers[2] were required to report data at the state level, based on the location of the contract. Like what was done last year, MFA has categorized the AHPEE data and presents key findings from its analysis of 2023 results.

• Traditionally, when health insurance is discussed, Government programs such as Medicare Advantage, Medicare Part D (PDP), Medicare Supplement, Medicaid, and State Children’s Health Insurance Programs (S-CHIP) are at the forefront of the conversation – and for good reason, as this category accounts for the largest share of premium dollars, at over $776.1 billion (B) in 2023, up 9.3% from $709.8B in 2022, and covers 111.1 million (M) lives[3], down -3.2% from 114.8M lives year-over-year.
• Government programs and comprehensive Major Medical coverage, comprised of the Federal Employer Health Benefits Program (FEHBP), Group (small, large, and multiple and other association & trust segments), and Individual (either purchased directly or through an exchange), are highly regulated – it is no surprise that the medical loss ratios for both categories are 85.9% and 85.7%, respectively.
• Non-comprehensive (Non-Comp) medical, a broad category with nearly 436M enrolled, down from 471M enrolled in 2022, is among the most profitable A&H categories with a loss ratio of 70%. This combination consists of Group and Individual Long- and Short-Term Disability, Long Term Care (LTC), Accident, Named Disease, Limited Benefit, and Student plans. These policies are also among the lowest cost products at $18 per member per month (PMPM).
• Ancillary plans, including dental and vision coverage purchased either individually or as part of a group, have a higher loss ratio than Non-Comp medical, 77%, but premiums also average $18 PMPM.
• Administrative Services Only (ASO) is the second largest category based on covered lives and includes both Administrative Services Only and Administrative Services Contract type arrangements[4], as well as other Credit and Stop Loss products.

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates' Health Coverage Portal™ database and sourced from health insurance companies reporting through the NAIC (National Association of Insurance Commissioners) via the Accident and Health Policy Experience Exhibit (AHPEE). This analysis may exclude a small number of plans that have not yet filed 2023 Annual data. Mark Farrah Associates' Health Coverage Portal™, A&H Policy Experience Exhibit by State table presents summary level data including premiums, claims, lives, member months, and number of policies for multiple health insurance segments, as mentioned above. This table does not include data for plans regulated by the California Department of Managed Health Care and not all health insurers are required to file with the state insurance departments. This table presents data for NAIC plans licensed as Fraternal, Life, Property, & Health. MFA’s A&H tables exclude non-health related segments, such as life, property, or flood policies. In 2021, the Accident and Health Policy Experience Exhibit (AHPEE) was modified to provide state insurance regulators with additional data and improve consistency across the annual financial statements. The AHPEEs prior to 2022 are available but not compatible with 2022 and 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™, 5500 Employer Health ^plus, Medicare Business Online™, Medicare Benefits Analyzer™, 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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