January 29, 2015

Report Shows HMO Membership Growth, Decreased Income

Florida's full implementation of the Medicaid Managed Medical Assistance (MMA) program, along with the overwhelming participation in the ACA Health Insurance Exchange, resulted in Florida's HMO enrollment growing by 46 percent, adding 1.5 million members over the 12 months ending Sept. 30, 2014.

Medicaid HMO members accounted for 41 percent of total HMO membership, followed by commercial membership at 39 percent of the total. As of Sept.30, 2014, over 1.3 million Medicaid recipients were covered by HMOs, with 846,600 added this year. Wellcare is the largest Medicaid plan with 627,800 members or almost 30 percent of the Medicaid MMA population. Sunshine State Health Plan ranks second with almost 400,000 Medicaid members. Florida's commercial HMOs gained 581,000 members, an increase of 40 percent. Aetna/Coventry has the largest commercial enrollment with 545,000 members, followed by Humana with 400,000 and Health Options/Florida Healthcare Plan with 350,000.

Despite the growth in membership, net income for Florida's HMOs dropped 67 percent compared to the same period in 2014. Profit margins fell from an average of 3.5 percent for the first nine months of 2013 to less than 1 percent for the same period in 2014. Premium revenue per member per month was up almost 6 percent, while medical expenses per member per month (PMPM) were up 9 percent and PMPM administrative costs were up 15 percent.

In addition, the number of Floridians selecting a plan on the Healthcare Insurance Marketplace reached over 1.3 million as of Jan. 23, 2015. In total over 7.2 million individuals have selected plans through the Federal exchange. Florida has the highest number of residents selecting plans on the exchanged, followed by Texas with 940,707. View enrollment data online.

Detailed information by plan and by metropolitan area is included in the two FHA publications,  FHA Eye on the Market: HMO Indicators and  FHA Eye on the Market: HMO Market Share . Order forms form for both reports are available  online . For more information, contact  Kim Streit , vice president of health care research and information, at (407) 841-6230.