Strong Medicare Advantage Returns Help NY Health Plans, Says Report

Joe Cantlupe, for HealthLeaders Media , March 18, 2010

But aggregate health plan profits were reported below $800 million for the first time since 2001 and Article 43 insurers, which operate HMOs and indemnity plans under nonprofits, posted losses of $166 million, compared to gains of more than $480 million in 2006. The report stated it was a "very difficult year" for Article 43 corporations, making them a glaring exception among the portfolios.

"Enrollment in commercial markets continues to decline, there's a growing dependence on public insurance programs, and our state is fact the biggest fiscal challenge in decades," stated Jim Fallon, fund president, in a statement. "These concurrent trends are cause for concern."

Among the report's findings:

  • Despite a decline in commercial group enrollment of more than 500,000, the loss of 200,000 jobs in New York between July 2008 and July 2009, and modest inflation rates, health plans collected more than $46 billion in premiums for coverage in 2008, an 11% jump over the 2006 level.

  • The state's Prepared Health Services Plans, which specialize in public managed care programs, such as Medicaid Managed Care and Family Health Plus, increased their collective market share to 12%, reflecting growing enrollment in public programs; two of these plans— Fidelis and HealthFirst—each exceeded $1 billion in premiums for the first time.

  • HMOs earned less money on their small group business than they did on their individual and Healthy NY programs.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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