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Health-Insurance Q3 Data Snapshot: Membership Trends

In a previous data snapshot, membership trends at the big managed-care companies looked good almost across the board, rising anywhere from two to 16 percent. The real story, however, is significantly less rosy.

Let's start with trends in fully-insured health plans offered to employers, the traditional bread-and-butter of mainline health-insurance providers like WellPoint and UnitedHealth Group. Because insurers are able to capitalize on the upside risk of these plans, they're generally much more profitable than these companies' other major products -- administrating self-funded health plans that are actually insured by employers themselves. First, let's look at the trends in fully-insured membership (all figures in this post refer to membership as of Sept. 30 and its change since the previous year):

Fully-Insured Commercial Health-Plan Membership Trends

Company Membership %Change
WellPoint 16.7 million -3.2%
UnitedHealth Group 10.5 million -3.5%
Aetna 5.5 million +4%
Humana 1.9 million +9.4%
Cigna 1.7 million -10%
Coventry 1.5 million -4.8%
Not a pretty picture. From what I've been able to glean so far, Humana's gains here largely reflects a competitive push in the fully-insured market, principally based on high-deductible "consumer-directed" plans and a strategic decision to keep its premiums in this segment flat. Aetna attributed its growth to contract wins with several large employers.

By contrast, let's take a look at the self-funded segment on the next page.

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Self-funded Commercial Health-Plan Trends
Company Membership %Change
WellPoint 18.7 million +6.2%
UnitedHealth Group 16.0 million +8.7%
Aetna 10.9 million +5.9%
Cigna 9.9 million +23%
Humana 1.6 million +5.7%
Coventry 720,000 -2.3%
Cigna, by the way, gained 1.7 million self-insured members thanks to its acquisiton of Great-West Healthcare. The decline at Coventry reflects bigger problems for the insurer, here primarily resulting from the conversion of fully-insured accounts to self-funded plans.

Finally, we'll take a quick look at the Medicare business, in which health plans take federal subsidies ranging from 13-17 percent to offer a privatized form of Medicare for enrollees.

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Medicare Health-Plan Membership Trends
Company Membership %Change
UnitedHealth Group 1.5 million -8%
Humana 1.4 million -20%
Coventry 377,000 +32%
Aetna 365,000 +91%
Cigna 35,000 -9.4%
Aetna's growth over this period largely reflects its first-quarter conversion of 100,000 members to Medicare Advantage from a commercial self-insured plan. Coventry said its greater Medicare membership resulted from "organic growth" and expansion into new areas. In any event, it's particularly interesting to see which insurers are pulling back from Medicare and which are charging ahead, especially since the political winds are not particularly favorable for the Medicare market, as Congress is showing greater interest in scaling back or terminating the federal subsidy for this business.

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