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Section 7: Health Plan Companies
Page 3 – Ways to Describe Health Plan Companies and Coverage Types
This illustration shows how health plan companies can be organized, and what types of health insurance coverage they offer.
- Health Plan Company Organization:
- For Profit – can be a Health Maintenance Organization (HMO) (such as UnitedHealthcare of Illinois, Inc.) or an Insurance Company (such as HealthPartners Insurance Company or Medica Insurance Company)
- Non-Profit – can be a Health Maintenance Organization (HMO) (such as Blue Plus, HealthPartners, Inc., Medica Health Plans, or UCare Minnesota) or a Health Service Plan Corporation (such as Blue Cross Blue Shield of Minnesota)
- Types of Coverage Offered by Health Plan Companies
- Private (Commercial) Coverage
- Self Insured Coverage – where health plan companies offer claims processing, network rental, or both, to employers who chose to take on the risk of their employee’s health care cost through self-insurance.
- Fully Insured Coverage – including Large Group (50 or more employees), Small Group (2 to 50 employees), and Individual Market (such as plans purchased through MNsure). In fully insured plans, the health plan company takes on the risk of health care costs.
- Public Coverage
- State Public Programs, including Medical Assistance (Medicaid) and MinnesotaCare. Only HMOs can contract with the Minnesota Department of Human Services to offer this coverage.
- Medicare, including Medicare Cost plans, Medicare Part D (prescription drug) plans, and Medicare Advantage plans. Health Plan Companies have contracts with the federal government to offer these services.
- Private (Commercial) Coverage
- Figures are for illustration purposes only and do not include all health plan companies and all types of public and private coverage.
Page 6 – Health Plan Market Shares: Fully Insured Private Market
This graph shows the percent distribution of health plan company fully insured private market shares.
- 2012 (premium volume = $4.9 billion): BCBSMN =39.0%, HealthPartners = 30.2%, Medica = 20.7%, Other = 6.1%, PreferredOne = 4.0%, UCare = 0.0%
- 2013 (premium volume = $4.9 billion): BCBSMN =40.1%, HealthPartners = 27.9%, Medica = 21.9%, Other = 5.9%, PreferredOne = 4.3%, UCare = 0.0%
- 2014 (premium volume = $5.2 billion): BCBSMN =38.9%, HealthPartners = 27.2%, Medica = 18.5%, Other = 6.4%, PreferredOne = 9.0%, UCare = 0.0%
- 2015 (premium volume = $5.0 billion): BCBSMN =41.6%, HealthPartners = 30.8%, Medica = 16.6%, Other = 6.4%, PreferredOne = 4.0%, UCare = 0.5%
- 2016 (premium volume = $5.4 billion): BCBSMN =42.2%, HealthPartners = 29.8%, Medica = 18.4%, Other = 5.4%, PreferredOne = 3.3%, UCare = 1.0%
- 2017 (premium volume = $5.6 billion): BCBSMN =35.2%, HealthPartners = 32.0%, Medica = 20.9%, Other = 5.5%, PreferredOne = 4.1%, UCare = 2.4%
- 2018 (premium volume = $5.6 billion): BCBSMN =33.2%, HealthPartners = 32.5%, Medica = 23.0%, Other = 4.8%, PreferredOne = 3.4%, UCare = 3.1%
- 2019 (premium volume = $5.8 billion): BCBSMN =33.2%, HealthPartners = 30.8%, Medica = 24.1%, Other = 5.7%, PreferredOne = 3.8%, UCare = 2.4%
- 2020 (premium volume = $5.8 billion): BCBSMN =33.8%, HealthPartners = 28.8%, Medica = 22.2%, Other = 7.1%, PreferredOne = 4.9%, UCare = 3.1%
- 2021 (premium volume = $5.7 billion): BCBSMN =33.2%, HealthPartners = 27.4%, Medica = 22.1%, Other = 8.4%, PreferredOne = 4.8%, UCare = 4.2%
- Companies with common ownership were treated as one entity. For example, BCBSMN includes Blue Cross Blue Shield of MN and Blue Plus. Fully insured private (commercial) market only, market share based on medical premium volume only; it does not include dental premium volume. Market shares for small group and individual markets are available in Health Care Markets Chartbook Section 4. UCare entered the private market in 2014.
- Source: MDH Health Economics Program, analysis of Health Plan Financial and Statistical Reports which covers health plan companies with over $3 million in annual premium revenue, as well as non-profit health plan companies. Data as of March 8, 2023.
Page 7 - Market Share of Minnesota Non-Profit Health Plan Companies and HMOs: Fully Insured Private Market
This graph shows the market share by non-profit health plan companies and HMOs.
- 2012 (premium volume = $4.9 billion): Non-Profit HMO= 18.9%, Non-Profit Health Service Plan Corporation = 38.3%
- 2013 (premium volume = $4.9 billion): Non-Profit HMO= 15.9%, Non-Profit Health Service Plan Corporation = 39.8%
- 2014 (premium volume = $5.2 billion): Non-Profit HMO= 14.9%, Non-Profit Health Service Plan Corporation = 38.8%
- 2015 (premium volume = $5.0 billion): Non-Profit HMO= 16.7%, Non-Profit Health Service Plan Corporation = 41.5%
- 2016 (premium volume = $5.4 billion): Non-Profit HMO= 16.7%, Non-Profit Health Service Plan Corporation = 44.3%
- 2017 (premium volume = $5.6 billion): Non-Profit HMO= 25.0%, Non-Profit Health Service Plan Corporation = 33.8%
- 2018 (premium volume = $5.6 billion): Non-Profit HMO= 26.0%, Non-Profit Health Service Plan Corporation = 29.9%
- 2019 (premium volume = $5.8 billion): Non-Profit HMO= 22.2%, Non-Profit Health Service Plan Corporation = 30.3%
- 2020 (premium volume = $5.8 billion): Non-Profit HMO= 21.6%, Non-Profit Health Service Plan Corporation = 30.5%
- 2021 (premium volume = $5.7 billion): Non-Profit HMO= 22.6%, Non-Profit Health Service Plan Corporation = 29.5%
- Fully insured private (commercial) market only, market share based on medical premium volume only; it does not include dental premium volume. Non-profit health plan companies include both non-profit HMOs and non-profit health service plan companies, which pay a 1.0 percent premium tax. HMOs are licensed pursuant to Minnesota Statutes, chapter 62D and Minnesota Rules, part 4685.
- Source: MDH Health Economics Program, analysis of Health Plan Financial and Statistical Reports which covers health plan companies with over $3 million in annual premium revenue, as well as non-profit health plan companies. Data as of March 23, 2023.
Page 11 – Minnesota HMO Net Income by Product Line
This graph shows the Minnesota HMO net income by product line for 2022.
- Total MN Products = $668.8 million
- PMAP = $431.3 million
- MSC+, MSHO, and SNBC = $232.5 million
- MNCare = $36.6 million
- Medicare = $21.3 million
- Other = -$5.6 million
- Commercial = -$47.3 million
- Minnesota products only. Excludes Administrative Services, Foundation, and Business Development Net Income and Revenue. The total includes “other” coverage (standalone Medicare Part D, Medicare Supplement, Medicare Select, Risk Corridor, and Dental). Definitions are included on slide 5. Product lines are in order of net income. Product lines are in order of net income.
- Source: MDH Health Economics Program analysis of Minnesota Supplement #1 HMO report.
Page 12 – Minnesota HMO Profitability by Product Line
This graph shows the net income as a percent of revenue by product line for 2022.
- Total MN Products = 4.4%
- PMAP = 6.9%
- MSC+, MSHO, and SNBC = 6.5%
- MNCare = 5.7%
- Medicare = 0.9%
- Other = -2.8%
- Commercial = -2.1%
- Minnesota products only. Excludes Administrative Services, Foundation, and Business Development Net Income and Revenue. The total includes “other” coverage (standalone Medicare Part D, Medicare Supplement, Medicare Select, Risk Corridor, and Dental). Definitions are included on slide 5. Product lines are in order of net income.
- Source: MDH Health Economics Program analysis of Minnesota Supplement #1 HMO report.
Page 13 – Minnesota HMO Net Income per Member Month by Product Line
This graph shows the Minnesota HMO net income per member month by product line for 2022.
- Total MN Products = $34.59 per member month
- PMAP = $38.05 per member month
- MSC+, MSHO, and SNBC = $160.12 per member month
- MNCare = $30.12 per member month
- Medicare = $9.61 per member month
- Other = -$22.27 per member month
- Commercial = -$16.52 per member month
- Minnesota products only. Excludes Administrative Services, Foundation, and Business Development Net Income and Revenue. The total includes “other” coverage (standalone Medicare Part D, Medicare Supplement, Medicare Select, Risk Corridor, and Dental). Definitions are included on slide 5. Product lines are in order of net income.
- Source: MDH Health Economics Program analysis of Minnesota Supplement #1 HMO report.
Page 18 - Total Minnesota HMO Reserves Relative to Regulatory Minimum Levels
This graph shows HMO reserves relative to regulatory minimum levels.
- 2013=653.1%
- 2014=696.8%
- 2015=699.8%
- 2016=561.4%
- 2017=556.6%
- 2018=575.5%
- 2019=579.5%
- 2020=603.8%
- 2021=574.8%
- 2022=638.5%
- Source: MDH Health Economics Program analysis of data from National Association of Insurance Commissioners (NAIC). Only health plan companies that are domiciled within Minnesota. PreferredOne Community Health Plan ceased prior to December 31, 2021 and therefore had no expenses. Medica Community Health Plan reserve data was not available on a Minnesota-specific basis after 2017.
1The Regulatory Minimum Levels are otherwise known as the Company Action Level and is defined at 200 percent. For more information, see Minnesota Statutes Chapter 60A.50.
2Reserve minimums are based financial solvency of entire organization; therefore, the calculation includes non-Minnesota business.
3“Regulatory level” is the authorized control level; total expenses is from line 16 of HMO Minnesota Supplement Report #1 and includes Administrative Services’ Expenses, as applicable.
Page 20 – Share of Total Minnesota HMO Enrollment
- This graph shows the distribution of Minnesota residents enrolled in a HMO or non-HMO product.
- 2017: Non-HMO = 78.0%, HMO = 22.0%
- 2018: Non-HMO = 77.9%, HMO = 22.1%
- 2019: Non-HMO = 77.6%, HMO = 22.4%
- 2020: Non-HMO = 75.1%, HMO = 24.9%
- 2021: Non-HMO = 72.9%, HMO = 27.1%
- Enrollment figures are as of December 31st of each year for Minnesota residents; excludes residents with an unknown county of residence. Data includes all HMO reported enrollment, even for program types which may not be primary medical coverage (e.g., standalone Part D, Medicare Supplement, and Medicare Select). As such, HMO enrollment may be overstated.
- Source: MDH Health Economics Program analysis of MDH Health Economics Program analysis of Minnesota Supplement #6 HMO report; U.S. Census Bureau, Annual Estimates of the Resident Population for Counties in Minnesota: April 1, 2020 to July 1, 2021, (CO-EST2021-POP-27).
Page 21 – Minnesota’s Percent of Population Enrolled in an HMO, by County, 2021
- This map shows the distribution of Minnesota HMO enrollment as of December 31st by county in 2021. Counties falling into each quintile are ordered least to greatest.
- 2.4%-10.4%: Beltrami, Big Stone, Clearwater, Douglas, Goodhue, Hubbard, Itasca, Kanabec, McLeod, Meeker, Pipestone, Pope, Renville, Sibley, Steele, Stevens, Traverse, Waseca
- 10.5%-22.7%: Blue Earth, Brown, Dodge, Grant, Le Sueur, Lincoln, Martin, Nicollet, Olmsted, Pennington, Red Lake, Rock, Roseau, Scott, Wabasha, Winona, Wright
- 22.8%-26.8%: Carlton, Carver, Clay, Freeborn, Houston, Jackson, Lac Qui Parle, Lyon, Murray, Otter Tail, Pine, Rice, Sherburne, St. Louis, Todd, Washington, Watonwan, Wilkin
- 26.9%-29.4%: Becker, Chippewa, Chisago, Crow Wing, Dakota, Fillmore, Kittson, Koochiching, Lake, Lake of the Woods, Mower, Polk, Redwood, Stearns, Swift, Yellow Medicine
- 29.5%-44.1%: Aitkin, Anoka, Benton, Cass, Cook, Cottonwood, Faribault, Hennepin, Isanti, Kandiyohi, Mahnomen, Marshall, Mille Lacs, Morrison, Nobles, Norman, Ramsey, Wadena
- Enrollment figures are as of December 31st of each year for Minnesota residents; ranges are based on quintiles; excludes residents with an unknown county of residence. Data includes all HMO reported enrollment, even for program types which may not be primary medical coverage (e.g., standalone Part D, Medicare Supplement, and Medicare Select). As such, HMO enrollment may be overstated.
- Source: MDH Health Economics Program analysis of MDH Health Economics Program analysis of Minnesota Supplement #6 HMO report; U.S. Census Bureau, Annual Estimates of the Resident Population for Counties in Minnesota: April 1, 2020 to July 1, 2021, (CO-EST2021-POP-27); map shapefile from 2021 Mapbox @OpenStreetMap.
Page 24 – Minnesota HMO Enrollment by Firm
- This graph shows Minnesota HMO market penetration for the commercial and public market segment as a percent of the total Minnesota population.
- 2017 (population = 5.6 million): Commercial = 4.0%, Public = 18.0%
- 2018 (population = 5.6 million): Commercial = 4.2%, Public = 17.9%
- 2019 (population = 5.6 million): Commercial = 4.1%, Public = 18.3%
- 2020 (population = 5.7 million): Commercial = 3.9%, Public = 21.0%
- 2021 (population = 5.7 million): Commercial = 3.9%, Public = 23.2%
- Enrollment figures are as of December 31st of each year; excludes residents with an unknown county of residence. Medica no longer accepted enrollment for Medical Assistance/MinnesotaCare Families and Children effective May 1, 2017. All Other is excluded from this graph and represents between 0.0% to 3.1% each year.
- Source: MDH Health Economics Program analysis of MDH Health Economics Program analysis of Minnesota Supplement #6 HMO report; U.S. Census Bureau, Annual Estimates of the Resident Population for Counties in Minnesota: April 1, 2020 to July 1, 2021, (CO-EST2021-POP-27).
Page 25 – Distribution of Minnesota HMO Enrollment by Product Line
- This graph shows the distribution of total Minnesota HMO enrollment by product line.
- 2017 (population = 5.6 million): All Other = 0.0%, MinnesotaCare = 7.0%, MSC+, MSHO, SNBC = 7.5%, Medicare = 11.4%, Commercial = 18.4%, PMAP = 55.7%
- 2018 (population = 5.6 million): All Other = 0.1%, MinnesotaCare = 7.0%, MSC+, MSHO, SNBC = 8.1%, Medicare = 11.7%, Commercial = 19.1%, PMAP = 54.0%
- 2019 (population = 5.6 million): All Other = 3.1%, MinnesotaCare = 6.1%, MSC+, MSHO, SNBC = 8.1%, Medicare = 12.3%, Commercial = 18.4%, PMAP = 52.0%
- 2020 (population = 5.7 million): All Other = 2.4%, MinnesotaCare = 6.2%, MSC+, MSHO, SNBC = 7.7%, Medicare = 11.1%, Commercial = 15.7%, PMAP = 57.0%
- 2021 (population = 5.7 million): All Other = 1.3%, MinnesotaCare = 6.4%, MSC+, MSHO, SNBC = 7.5%, Medicare = 11.9%, Commercial = 14.6%, PMAP = 58.3%
- Enrollment is based on total member months. Minnesota products only. MSC+ data prior to 2017 was not consistently broken out by health plan companies and is included in the MSC+ category, as able. Definitions are included on slide 3. “All Other” enrollment includes all HMO reported enrollment, even for program types which may not be primary medical coverage (e.g., standalone Part D, Medicare Supplement, and Medicare Select). As such, enrollment may not be unique between product lines.
- Source: MDH Health Economics Program analysis of Minnesota Supplement #6 HMO report.
Appendix - Minnesota Counties and Regions Used in the Geographic Analysis
- The map shows the regions used within geographic analysis of this chartbook. Regions are based on State Community Health Services Advisory Committee (SCHSAC) regions.
- Northeast: Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, St. Louis
- Northwest: Beltrami, Clearwater, Hubbard, Kittson, Lake of the Woods, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, Roseau
- West Central: Becker, Clay, Douglas, Grant, Otter Tail, Pope, Stevens, Traverse, Wilkin
- Central: Benton, Cass, Chisago, Crow Wing, Isanti, Kanabec, Mille Lacs, Morrison, Pine, Sherburne, Stearns, Todd, Wadena, Wright
- Southwest: Big Stone, Chippewa, Cottonwood, Jackson, Kandiyohi, Lac qui Parle, Lincoln, Lyon, Murray, Nobles, Pipestone, Redwood, Renville, Rock, Swift, Yellow Medicine
- South Central: Blue Earth, Brown, Faribault, Le Sueur, Martin, McLeod, Meeker, Nicollet, Sibley, Waseca, Watonwan
- Southeast: Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha, Winona
- Metro: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington
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