Mark Farrah Associates Analyzes Trends in Health Insurer Shifts from Commercial to Government Business

Mark Farrah Associates (MFA), www.markfarrah.com, previously noted health insurance enrollment shifting from commercial risk to government business. In a newly released Business Strategy report, using data gleaned from MFA’s 5500 Employer Health ^Plus and other products, it highlights two carriers, Fallon Health Group and Humana. Both entities have announced plans to transition away from Commercial business to focus more on Government business lines.

In March of 2021, Fallon Health Group was one of the first carriers to announce a shift to predominately focus on government programs.

• Fallon’s commercial risk enrollment in Massachusetts consistently decreased over the period, dropping over 42,000 members (-70.9%) from 2018 to the end of 2022.

• Examining MFA’s 5500 EHP data, regarding Insurers, in 2018, Fallon was the insurer for 62 employers/sponsors; By year-end 2021 that number was 22. Fallon’s remaining accounts are expected to be fully transitioned to other carriers in 2023.

In February of 2023, Humana announced its intent to exit the employer group market and turn its focus on government business lines.

• Like Fallon, Humana’s Commercial risk declines began before its re-focus announcement. Since year-end 2018, Humana’s Commercial risk enrollment has declined -37.7%., representing a drop of approximately 590,000 insured. On the Government side, Medicaid enrollment for Humana nearly doubled from 500,000 to over 1 million, and Medicare grew nearly 1.4 million in the same time frame.

• As Humana transitions out of the commercial risk market, MFA’s products help identify Employers, Brokers, Administrators, and quantify the participants and insured directly impacted by its decision.

About 5500 Employer Health ^Plus

MFA’s 5500 Employer Health ^Plus has been designed to simplify the analysis of employer health & welfare benefits including medical, dental, vision, disability and other benefits. This tool uniquely focuses on health & ancillary benefits purchased by private sector employers and the relationships employers have with contracted insurers, administrators, and brokers. The user interface allows for both detailed and summary level data retrieval. Data sources include Form 5500 filings and related schedules for plans that have the indication of providing health & welfare benefits.

To read the FREE full text of “Trends in Health Insurer Market Shifts from Commercial Risk to Government Business," visit the Analysis Briefs library on Mark Farrah Associates' website.

About Mark Farrah Associates (MFA)

MFA is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Committed to simplifying analysis of health insurance business, our products include: Health Coverage Portal™, Medicare Business Online™, Medicare Benefits Analyzer™, County Health Coverage™, Health Plans USA™ and 5500 Employer Health ^Plus. Follow us on LinkedIn!

Also, for the latest insights about health plan enrollment trends and financial performance, visit the FREE MFA Healthcare Business Strategy Briefs on the MFA website.

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