Michigan’s health insurance market is the second least competitive in the country

Michigan remained one of the least competitive states in the nation for employee health insurance in 2022, although the trade association representing Blue Cross Blue Shield of Michigan’s competitors says research shows they have made smaller gains over the past few years. Have made profits.

Michigan again ranked as the second least competitive state in an annual report by the American Medical Association as Blue Cross Blue Shield had two-thirds statewide market share across all health plan types. Grand Rapids-based Priority Health is second with 12% statewide market share.

According to the AMA, the only state that was less competitive than Michigan in 2022 was Alabama, where Blue Cross Blue Shield plans have 86% market share.

Blue Cross Blue Shield of Michigan has long been the dominant health plan in the state. While the AMA cites the large market share that Detroit-based Blue Cross Blue Shield holds that has historically made Michigan an uncompetitive market, a spokesperson says the annual report data only reflects customer preferences and employee health in the state. There is competition for coverage.

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The AMA’s findings don’t match the reality that, here in Michigan, employers and consumers in every health insurance segment have a choice of carriers, said Andy Hetzel, blue cross blue shields Vice President of Corporate Communications. The fact that Blue Cross remains the preferred health insurance brand for most Michigan employers and consumers should not be mischaracterized as the result of an uncompetitive market, when it is more accurately reflective of a company that which has maintained its industry-leading value proposition amid a strong sector. Competitive.

Blue Cross Blue Shields’ 67% statewide market share by 2022, a decline of one percentage point from the previous year, came in HMOs, PPOs, point-of-service health plans and individual policies sold on the public health exchange. According to the AMA report, the Blues led by wide margins in all metropolitan statistical areas in the state, although rival Priority Health held a slight lead in West Michigan from 2021 to 2022.

Grand Rapids, where Blue Cross Blue Shield had 53% market share in 2022, while Priority Health had 32%, was the most competitive market in the state. Priority Health gained two percentage points in market share in the Grand Rapids area from 2021 to 2022, while Blue Cross Blue Shield declined at the same rate.

The next closest market to competition was Muskegon, in which Blue Cross Blue Shield held a market share of 62% to Priority Health’s lead of 26%. That compares with 63% for Blue Cross and 24% for Priority Health a year ago.

Blue Cross Blue Shield was even more dominant for PPO health plans, with 78% of the statewide market, while Aetna had 8%. CVS Health Corporation Blue Cross Blue Shield gained PPO market share by equally large margins in markets across the state. they include:

  • 73% 10% for priority health in the Grand Rapids area,
  • Cygnas 5% to 86% in Kalamazoo area,
  • Priority health in Muskegon 77% 9%,
  • 80% to Aetnas in the Niles-Benton Harbor MSA, and
  • Priority Healths in Battle Creek 86% 4%.

The AMA analyzes the data annually and releases a report that identifies the top two market-share leaders in 381 metropolitan statistical areas across the country.

As the 2023 annual report shows Blue Cross Blue Shields continues to have a solid hold on the statewide market, the Michigan Association of Health Plans cites its own data that shows incremental gains by members.

MAHP members combined have a 26.5% market share in 2022 for small and large group, individual and self-insured health policies covering more than 5.5 million people, compared to a collective 21.75% in 2020.

Blue Cross Blue Shields’ market share among similar health plans declined from 75.4% in 2020 to 70.94% in 2022, according to MAHP data.

2022 alone “Our members had the most significant increases in total market share and total lives insured, as the collective market share of MAHP members increased by three and a half percentage points from 2021,” Brian Mills, the association’s deputy director of commercial markets and communications, wrote in an email. Crain’s Grand Rapids Business,

Our members continue to make gains in the commercial market, Mills said. MAHP members’ market share has grown in the commercial market, and they are proud of members’ diverse offerings and their growth in market share.

A state law needs to be passed in autumn 2022 Mills said providing medical claims data to employers so that insurance carriers can bid on employee health coverage could help them gain further profits. next year “This will be the first full year that our members will be able to use this tool to encourage more employers to buy in,” he said.

Nationally, the AMA concluded that approximately three-quarters of markets across the US are highly concentrated.

The authors of the AMA’s annual report wrote that most health insurance markets are ripe for health insurers to exercise market power, which harms consumers and care providers.

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