McKinsey Enrollment Infographic v26
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Transcript of McKinsey Enrollment Infographic v26
Health insurance enrollment and revenue shifts 2013-2014An emerging story
By enrollment By revenue
2013100% = 230 million
2014100% = 247 million
Percentage share of enrollment
Medicare Part C, DSmall Group (SG)1
22
716
5
9
41
19
7
20
7
7
40
Percentage share of revenue from premiums
2013100% = $641 billion
3328
19
512
3
Absolute enrollment and revenue have also grown, by 17 million lives and $86 billion, respectively
2014100% = $743 billion
29
327
710 24
Change in enrollment (millions) Change in revenue ($ billions)2013 – 2014
2302
2013 Mcare Part C, D
2013 – 2014
641
2013 Mcare Part C, D
Share of payors' aggregate enrollment and revenue in Medicaid and the Individual market has grown
Year 1 financials: the Individual market
Although Individual market revenues have grown, payors lost $2.5 billion in 2014 there, after reinsurance and risk adjustment
All findings based on publicly available sources.
For enrollment and revenue shifts: Estimated enrollment is based on the following sources: CMS enrollment reports (Medicare); NAIC financials, IRS 990 reports, select state websites, DMHC reports (Medicaid); NAIC financials, DMHC reports (Individual, Small Group, Large Group); Kaiser (ASO). Estimated revenues, based on McKinsey Payor Financial Database, which includes NAIC financials of SHCE filings, DMHC filings, IRS 990 forms, DMHC financials, select state websites.
For year 1 financials: We analyzed all available 2014 Supplemental Healthcare Exhibits filed by payors for their Individual medical insurance business (comprising 92% of payors). Profitability is based on reported post-tax margin adjusted for the difference between reinsurance and risk adjustment (as booked at the end of 2014) and CMS reported reinsurance and risk adjustment payments as of 06/30/2015, assuming a corporate tax rate of 35%. Risk adjustment bookings were attributed to the Individual line of business based on relative proportion of reported member months. The effect of risk corridors were not included as carrier-specific risk corridor data has not yet been released.
2014 Individual market post-2R operating gain/loss3
‑$2.5BEstimated market-wide loss ‑$163Estimated
full year loss per member
2014 performance in the Individual market varied among payors — most lost money, but ~35% made money
29
05375
1024
36
Enrollees, %
418
2328
158
229Payors, %
Loss >$50M
Loss$40 – 50M
Loss$30 –40M
Loss$20 – 30M
Loss$10 –20M
Loss$0 – 10M
Gain$0 – 10M
Gain$10 – 20M
Gain$20 – 40M
Gain$40M+
16
10 247
Mngd Mcaid
Ind SG1 2014
4
ASOLG1
2
5
2 Self-insured of all employer sizes; excludes stop loss revenue
Mngd Mcaid
Ind SG1 2014ASO2LG1
57
22
4
733
2<1
6
Methodology
McKinsey Center for U.S. Health System Reform
McKinsey Center for U.S. Health System Reform
Managed Medicaid IndividualLarge Group (LG)1 Administrative Services Only (ASO)2
1 Fully insured only
3 Includes ACA compliant (on and off exchange) and non-ACA compliant plans
healthcare.mkinsey.com/reform