ECG's Payer Services practice is proud to present its inaugural Health Plan Quarterly Report. The report evaluates NAIC Financial Statement Filings for every health plan in the market. The first iteration of the report is for filings through the fourth quarter of 2024, which are required to be filed by April 1, 2025.
In each report, ECG's Payer Services practice will derive and analyze key insights on important health plan financial metrics, making comparisons by insurer and plan category, which will benchmark the performance of national affiliates, provider-sponsored health plans (PSHPs), and other regional health plans. While many editorials track the performance of public health insurers, it is important to understand the performance of private health plans, specifically PSHPs and other regional health plans, in which ECG’s Payer Services team has deep expertise. The report will also highlight key trends or developments impacting the industry.
Here are three takeaways from ECG's Q4 2024 Health Plan Quarterly Report:
- The industry is continuing to experience rising medical expenses relative to premiums, with medical cost ratios increasing 250 basis points year over year.
- With expense ratios of around 9.5%, PSHPs and regional plans are challenged to create the same administrative efficiency as national plans (8.1% expense ratio).
- Aetna is in a strategic growth mode, increasing top-line premium revenue (26.9% year-over-year premium growth) while decreasing pretax operating margins from 0.6% in 2023 to -1.7% in 2024.
