Small and medium-sized health plans represent 83 percent of market

May 8, 2019

According to a recent study by Edifecs, small and medium-sized health plans cover fewer than 500,000 lives represent 83% of all coverages in the United States, while these businesses make-up 409 of the country's 493 health insurance plans. 

 

The study sheds light into the market's growth, consolidation and competitive landscape, according to Mary Swaykus, senior analyst, Product Marketing, at Edifecs and the paper's author.

 

It shows where the market is heading.

 

Medicare Advantage seems to be the growing trend, with 35% of small and medium businesses offering their plan, with Medicaid following at 35%. 

 

Healthcare reform is driving the managed Medicaid business, Swaykus said. This drive towards smart costs, what is essentially value-based care, is a way for insurers to understand what they're paying for.

 

 

Of the estimated 216 provider-sponsored health plans, 94 percent fall into the small and medium business category.

 

Provider-sponsored plans represent more than half, 53 percent of the SMB market.

 

Eighty-seven percent of small and medium-sized plans offer some line of government business.

 

Thirty-three percent take on commercial risk.

 

Of the nation's estimated 493 health plans, 100 cover fewer than 500 lives.

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