健康保险公司金融脉搏 2026年夏季刊

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 youabreast of key market trends and dynamics that impact health insurer financial results and profitability. We hopeyou enjoy the newsletter and find it informative. Please look for our next edition in Fall2026. 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.Overall, carriers of all types showed significant decreases in their RBC ratios in 2024 and2025. Capital management andreinsurance In 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 potentialcapital solutions to help withstand financialheadwinds. In thisissue Health insurer financials by market3Large public companies’ financial performance8Market capitalization: Statutory capital/RBC trends14Capital management and reinsurance17 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,pre-tax margins decreased in 2025 to-0.9%, with increased loss ratios in all lines of business except for MedicaidManaged Care compared to2024. Allmarkets Commercial, Medicare, Medicaid, andother Profitmargin All markets pre-tax profitmargin Margins in 2025 decreased for public companiesand non-public Blues, and increased for otherhealthcarriers. 2020 to 2025/public vs. blues vs.other Pre-tax profit margin (as % ofpremium) Public companies decreased from 1.6% in 2024 to1.1% in 2025. Non-public Blues and other healthcarriers reported negative margins at-3.6%and-1.9%,respectively. Groupmarket1 PremiumsPMPM Commercial group premiumsPMPM Group premiums PMPM increased in 2025, with averagemarket premiums reaching $617 PMPM, an increaseof 6.3% from 2024. Public companies’ premiums sawthe greatest increase in 2025 (7.4%) while other healthcarriers saw the smallest increase(5.7%). Public vs. blue vs.otherPremium PMPM ($) Enrollment2 Commercial groupenrollment Enrollment in the comprehensive fully-insured groupmarket decreased in 2025, continuing the negative trendseen in the last fewyears. Public vs. blue vs.otherCovered lives (inmillions) Public companies’ enrollment decreased the most (8.9%),with non-public Blues and other health carriers bothcloser to the overall group market decrease of4.8%. Commercial group lossratio Lossratio The 2025 reported loss ratio of 89.9% is an increase of1.9% relative to 2024. Public companies (+2.4%) andnon-public Blues (+2.6%) drove the overall increase,while other health carriers saw little change(-0.1%). Public vs. blue vs.otherLoss ratio(%) Individualmarket1 PremiumsPMPM2 Comprehensive individual premiumsPMPM Individual premiums PMPM increased in 2025, withreported average individual market premiums of $566PMPM, an increase of 2.4% from2024. Public vs. blue vs.otherPremium PMPM ($) Public companies (5.7%) reported the largest increasefollowed by non-public Blues (2.0%), while other healthcarriers experienced a slight decrease(-0.4%). Comprehensive individualenrollment Enrollment3 Overall enrollment increased an average of 3.0% in 2025relative to2024. Public vs. blue vs.otherCovered lives (inmillions) Public companies and other health carriers bothincreased by 6.2%, offset by non-public Blues’ decreaseof4.2%. Comprehensive individual lossratio Lossratio2 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 companiesreporting the lowest loss ratio at 89.8% and non-publicBlues reporting the highest at97.4%. Public vs. blue vs.other © Oliver Wyman MedicareAdvantage1 Enrollment2 Medicaree