Improved Profit Margins for Aggregate Blue Cross & Blue Shield Plans in Third Quarter 2023

February, 2024

According to Mark Farrah Associates’ (MFAs) Health Coverage Portal™, as of September 30, 2023, Blue Cross Blue Shield (BCBS or Blues) membership comprised 37% of total U.S. health insurance (Individual plus Employer-based, for all funding types, Medicaid & Medicare) enrollment, or 119.7 million members. In this brief, Mark Farrah Associates (MFA) assesses year-to-date profit margins of BCBS plans, comparing year-over-year performance from September 2020 (3Q20) to September 2023 (3Q23), based on the National Association of Insurance Commissioners (NAIC) and the California Department of Managed Health Care (CA DMHC) statutory reporting.

The aggregate profit margins for all Blues plans (net income divided by total revenues) decreased from 6.1% as of 3Q20 to 3.9% in 3Q21. The aggregate profit margin fell further in 3Q22 to 3.0%, however, rebounded to 3.5% in 3Q23. Delving deeper into trend data that is available in MFA’s Health Coverage Portal shows that improved medical expense ratios and increased investment income are two notable factors driving the gain in profitability for the Blues.

Leading BCBS Profit Margin Performance

​The leading BCBS plans, based upon revenue, through the third quarter of 2023 (3Q23), include: Elevance (formerly Anthem), Health Care Service Corp. (HCSC), Guidewell Mutual Holding Group, Independence Blue Cross, and Blue Shield of CA. 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. Profit margins for the leading plans have had mixed results, due in part to portfolio differences. Year-to-date, profit margins, through 3Q22 and 3Q23, for these plans are illustrated below.

• Guidewell Mutual Holding Group experienced a notable drop in profit margins between 3Q20 and 3Q21, from 5% to 1.9%, however, as the table above shows, slightly increased its profit margin from 2% in 3Q22 to 2.7% in 3Q23.
   
• Independence Blue Cross Group (IBX), with 54% of its enrollment through Medicaid plans in nine states, experienced a marginal increase in profit margin from 3Q20 to 3Q21, from 1.8% to 2.1%, but decreased to 0.9% in 3Q22. For 3Q23 IBX had a profit margin of 1.2%, which was the lowest reported profit margin amongst leading Blues plans.
   
• Blue Shield of CA had a profit margin of 1.7% for 3Q23, an increase from -2.1% in 3Q22.
   
• Health Care Service Corp (HCSC) reported a profit margin of 3.9% in 3Q23, a decrease from 4.6% in 3Q22.
   
• Elevance Health continued to report the largest profit margin for top Blues plans of 4.9% in 3Q23, a decrease from 5.4% in 3Q22. The company experienced a steady increase in profit margin from 3Q20 to 3Q22.

Conclusion

Blues plans remain financially strong and continue to gain new members, year-over-year, overall profitability was up through 3Q23. Of the leading Blues plans, Guidewell, IBX and Blue Sheild of California reported improved profit margins, while Elevance and HCSC reported declines. Overall, the smaller Blues plans have performed better than the leading plans group, mostly due to reported increases in investment income.  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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