Articles from Sherlock Company

In 2024, core per member administrative expenses in Medicaid-focused plans grew by 5.0%, slower than the 5.3% growth in 2023. Total expenses increased by 3.6% versus 5.4% in 2023. Both trends hold constant universes and product mixes. Median Core costs were $44.49 PMPM (per member per month) for all surveyed health plans and their products. Median Core costs for Medicaid were $36.08 PMPM.

Holding product mix constant, Medicare Advantage plans’ per member costs grew by 3.6% in 2024 compared with 6.2% in 2023. A shift in health plan product portfolios to favor Medicare Advantage led to as reported growth of 6.4%, compared with 5.2% in 2023. Median PMPM costs for their Medicare Advantage product was $140.02.

Holding product mix constant, Independent / Provider-Sponsored plans’ per member costs grew by 6.2% in 2024 compared with 8.4% in 2023. The growth in Medicare Advantage and decline in Medicaid membership led to as reported growth of 9.5%, compared with 10.5% in 2023. Median PMPM costs for all reporting plans was $55.67 PMPM.

Holding product mix constant, Blue Cross Blue Shield Plans’ per member costs grew by 4.0% in 2024 compared with 5.6% in 2023 and 8.7% in 2022. The growth in Medicare Advantage and decline in Medicaid led to as-reported growth of 6.6%, compared with 5.9% in 2023. Median PMPM costs for all reporting Plans were $51.90 PMPM.

In 2023, Core per member administrative expenses in Medicaid-focused plans grew by 5.4% in 2023, faster than the 1.8% growth in 2022. After holding the product mix constant, the real core Cost growth rate was 5.3% compared to 2.4% in 2022. Holding mix constant, the growth in Account and Membership Administration grew by 3.9% compared with 5.7% in 2022. Core PMPM costs were $39.68.

In 2023, Medicare plan per member administrative costs grew by 6.2% compared to 1.9% in 2022. These comparisons hold constant the set of reporting plans and calculations eliminate the effect of product mix differences. Median PMPM costs for all reporting plans were $52.53.

In 2023, Independent/Provider-Sponsored plan per member costs grew by 8.7% compared to 7.5% in 2022. These comparisons hold constant the set of reporting plans and are reweighted to eliminate the effect of product mix differences. Median PMPM costs for all reporting plans were $45.70.

In 2023, Blue Cross Blue Shield Plans’ per member costs grew by 5.6% compared 8.7% in 2022. These comparisons hold constant the set of reporting Plans and are reweighted to eliminate the effect of product mix differences. Median PMPM costs for all reporting Plans were $46.59.

Health plans are expecting 2024 premiums to increase by 8.0% for Group fully-insured plans and by 6.1% for Individual plans. For Group plans, this growth is 0.7 percentage points higher than their expectations for 2023. For Individual plans, growth expectations are lower by 0.5 percentage points. Individual members include all who purchase insurance individually who are not eligible for Medicare or Medicaid.

In 2022, per member per month Core expenses increased by 2.4%, below the 2.6% increase in 2021. Core expenses exclude the plans’ Sales and Marketing expense clusters. Trends are of continuously reporting plans and eliminate the effect of product mix changes. Median PMPM costs for Medicaid HMO were $30.82, and $36.41 for all products.

In 2022, Medicare plans’ costs increased by 1.9% per member compared an increase of 0.6% in 2021. These comparisons are of continuously reporting plans after eliminating the effect of product mix differences between comparison years. Median PMPM costs for Medicare Advantage were $115.84.

In 2022, Independent/Provider-Sponsored plans’ costs increased by 7.5% per member compared an increase of 4.2% in 2021. These comparisons are of continuously reporting plans after eliminating the effect of product mix differences between the comparison years. Median PMPM costs were $41.16.

In 2022, Blue Cross Blue Shield Plans’ costs increased by 7.2% per member compared with a decline of 0.4% in 2021. These comparisons are between continuously reporting Plans after eliminate the effect of product mix differences between the comparison years. Median PMPM costs were $45.36.

Health plans are expecting 2023 premiums to increase by 7.2% for Group fully-insured plans and by 6.4% for Individual plans. For Group plans, this growth is 1.6 percentage points higher than their expectations for 2022. For Individual plans, growth expectations are higher by 3.6 percentage points. Individual members include all who purchase insurance individually who are not eligible for Medicare or Medicaid.

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.6% in 2021, decelerating from 2020’s increase of 5.8%. Core expenses exclude the plans’ Sales and Marketing expense clusters.

In 2021, administrative expenses for Medicare plans increased by 0.6% per member compared to a 5.6% increase in 2020. This trend is based on continuously reporting plans and eliminates the effect of product mix differences between comparison years. Median PMPM costs were $46.69, and $111.15 for MA.

In 2021, Independent / Provider – Sponsored plans’ costs grew by 4.2% per member compared with a decline of 1.0% in 2020 and growth of 7.6% in 2019. These comparisons are between continuously reporting plans and eliminate the effect of product mix differences between comparison years. Median PMPM costs were $45.65.

In 2021, Blue Cross Blue Shield Plans’ costs declined by 0.4% per member compared with growth of 5.2% in 2020 and 6.6% in 2019. These comparisons are between continuously reporting Plans and eliminate the effect of product mix differences between comparison years. Median PMPM costs were $41.66.

Health plans are expecting 2022 premiums to increase by 5.6% for Group fully-insured plans and by 2.8% for Individual plans. For Group plans, this growth is 0.7 percentage points higher than their expectations for 2021. For Individual plans, growth expectations are higher by 5.0 percentage points. Individual members include all who purchase insurance individually who are not eligible for Medicare or Medicaid.

In 2020, “Core” administrative expenses per member for Medicaid plans increased by 5.8%, faster than 4.4% in 2019. Core expenses exclude the Sales and Marketing expense cluster because of the nature of the Medicaid product.

In 2020, administrative expenses per member for Medicare plans in 2020 grew by 5.6%, slightly faster than the 5.2% in 2019. All clusters besides Corporate Services, which increased by almost 20%, decelerated in their rate of growth. This comparison is of continuously reporting plans and eliminates the effect of product mix changes between comparison years.

In 2020, Independent/Provider-Sponsored plans’ costs decreased by 1.0% per member, down from a 7.6% increase in 2019. The comparison is of continuously reporting plans and eliminates the effect of product mix changes between comparison years.

In 2020, Blue Cross Blue Shield Plans’ costs increased by 5.2% per member, down from 6.6% and 6.7% in 2019 and 2018, respectively. These comparisons are between continuously reporting plans and eliminate the effect of product mix differences between comparison years.