重塑健康保险公司业绩的三大主要趋势

Summer2026 We present the Summer 2026 edition of our Health Insurer Financial Pulse newsletter. This edition of Pulse includesthereported annual statutory financial experiencefor health insurers through 2025, highlights frompubliccompanies’ Q1 2026 financial statements, market capitalizationfor public companies and statutory capital/Risk-Based Capital (RBC) trends, and recentcapital management and reinsuranceactivity. Our aim is to keep you 2025 statutory financials reveal margin deterioration in Individual, Group, Medicare, andMedicaidmarkets Market-wide pre-tax margins decreased in 2025 to-0.9%, with increased loss ratios in all lines of business except forMedicaid Managed Care compared with2024. Large public companies’ Q1 2026 financial performanceimprovesTotal enrollment has dropped considerably, while unweighted average reported profit margins increased from Q12025 to Q1 2026 as carriers focus on margin improvement over membershipgrowth. 2025 RBC ratios show significant decline compared with2021Between 2021 and 2025, RBC ratios of health companies decreased by almost 100 percentage points, as AuthorizedControl Level (ACL) amounts grew more quickly than Total Adjusted Capital (TAC), likely due to higher loss ratios. Capital management andreinsuranceIn this section, we discuss the potential impacts of proposed changes to the Health Risk-Based Capital (HRBC) framework, specifically around underwriting risk and managed care credit components. We also discuss potential In thisissue Health insurer financials by market Large public companies’ financial performance 14 Market capitalization: Statutory capital/RBC trends Capital management and reinsurance Health insurer financials bymarket We summarize the profitability trends of carriers with full year 2025 reported statutory financial information.1Wealso summarize enrollment and loss ratio trends in the Individual, Group, Medicare, and Medicaid markets. Overall, Allmarkets Commercial, Medicare, Medicaid, andother All markets pre-tax profitmargin2020 to 2025/public vs. blues vs.other ProfitmarginMargins in 2025 decreased for public companies and non-public Blues, and increased for other Public companies decreased from 1.6% in 2024 to1.1% in 2025. Non-public Blues and other healthcarriers reported negative margins at-3.6% Groupmarket Commercial group premiumsPMPMPublic vs. blue vs.other PremiumsPMPMGroup premiums PMPM increased in 2025, with average market premiums reaching $617 PMPM, an increaseof 6.3% from 2024. Public companies’ premiums saw Premium PMPM ($) Enrollment Commercial groupenrollmentPublic vs. blue vs.other Enrollment in the comprehensive fully-insured groupmarket decreased in 2025, continuing the negative trend Covered lives (inmillions) Public companies’ enrollment decreased the most (8.9%),with non-public Blues and other health carriers both Commercial group lossratioPublic vs. blue vs.other LossratioThe 2025 reported loss ratio of 89.9% is an increase of Loss ratio(%) 1.9% relative to 2024. Public companies (+2.4%) andnon-public Blues (+2.6%) drove the overall increase, Individualmarket PremiumsPMPM Comprehensive individual premiumsPMPMPublic vs. blue vs.other Individual premiums PMPM increased in 2025, withreported average individual market premiums of $566 Premium PMPM ($) Public companies (5.7%) reported the largest increasefollowed by non-public Blues (2.0%), while other health Enrollment Comprehensive individualenrollmentPublic vs. blue vs.other Overall enrollment increased an average of 3.0% in 2025relative to2024. Covered lives (inmillions) Public companies and other health carriers bothincreased by 6.2%, offset by non-public Blues’ decrease Lossratio Comprehensive individual lossratioPublic vs. blue vs.other Reported loss ratios in 2025 increased significantly to93.4%, up 8.1% from 2024. All carrier types increasedbetween 7.0% and 8.9%, with public companies MedicareAdvantage Enrollment MedicareenrollmentPublic vs. blue vs.other Enrollment growth in the Medicare Advantage (MA)market continued in 2025, with the overall trend ofgradual increases driven by population demographicsand the continued popularity of MA plans. Growth Covered lives (inmillions) LossratioReported loss ratios in 2025 increased to 90.9%, a 1.1% Medicare lossratioPublic vs. blue vs.other increase from 2024. The increase is fairly even acrosscompany types, with non-public Blues increasing at Loss ratio(%) Medicaid managedcare Enrollment MedicaidenrollmentPublic vs. blue vs.other Enrollment decreased significantly by 9.8% in insuredManaged Medicaid programs in 2025 compared with2024. Public companies saw the lowest decrease at5.4%, followed by non-public Blues at 7.6% and other Covered lives (inmillions) Medicaid lossratioPublic vs. blue vs.other LossratioReported loss ratios in 2025 decreased to 90.7%, a 0.5% decrease from 2024. Other health carriers drove thedecrease at2.4%, while non-public Blues and