March 20, 2014

HMO Profits Fall 28 Percent, Enrollment Rises 7 Percent

Enrollment in Florida's HMOs increased 7 percent in the third quarter of 2013 compared to 3Q12, with membership at 3.7 million.


HMOs reported net income of $536.4 million for the first nine months of 2013 compared to $748.3 million for the first nine months of 2012, a 28.3 percent drop. Humana Medical Plan reported the highest net income, followed by Aetna Health Plan, CarePlus Health Plan, Health Options and Neighborhood Health. These five health plans had combined profits of $434.1 million, representing 80.9 percent of total HMO profits in Florida.  Eleven plans reported losses totaling $40.3 million during the period. Of these, three plans have been operational for less than three years. Profit margins averaged 3.2 percent, down from 4.8 percent in 3Q12. Three plans had profit margins greater than six percent.
Medical loss ratios increased 2.2 percent to 84.4 percent.  Four plans, Florida Healthcare Plus, Health Options, Neighborhood Health and Preferred Medical Plan failed to meet the 80 percent threshold. Physician and hospital care accounted for 76.1 percent of the total expenses. Administrative expenses as a percent of revenue averaged 8.8 percent. Premium revenue per member per month (PMPM) decreased 0.3 percent from 3Q12; averaging $504.72, while total expense PMPM rose 2.0 percent.


Additional information, including healthplan-specific financial trends and comparisons, are available in the FHA Eye on the Market: HMO Indicators Report.


For more information, contact Kim Streit, Vice President of Healthcare Research and Information, at (407) 841-6230.