health coverage
health coverage

Mark Farrah Associates Assessed Health Insurance Segment Profitability

MCMURRAY, Pa.–(BUSINESS WIRE)–Mark Farrah Associates (MFA), www.markfarrah.com, examined trends in membership, claims incurred PMPM (per member per month), adjusted premium PMPM, and MLR (Medical Loss Ratio) for the Individual and Small Group comprehensive segment leaders. Based on an analysis of the National Association of Insurance Commissioners’ (NAIC) Supplemental Health Care Exhibit (SHCE), MFA analyzed the profitability of both health insurance segments for 2021.

  • The Individual segment experienced enrollment growth of 16%, to 13.2 million members for 2021.

  • While the Small Group segment continues to lose membership, down another 5.1% for 2021 with small businesses opting to either self-insure or drop health insurance coverage for their employees, overall segment profitability remains strong.

  • While both the Small Group and Individual segments have been impacted by pandemic-influenced medical spending between 2020 and 2021, both segments were profitable for insurances over the two-year combined period.

To read the FREE full text of “health-insurance-markets-in-2021%2F&esheet=52782162&newsitemid=20220719005080&lan=en-US&anchor=An+Analysis+of+Profitability+for+the+Individual+and+Small+Group+Health+Insurance+Markets+in+2021&index=2&md5=b0209edd90239ef45f26ecddcc31ca1c” shape=”rect”An Analysis of Profitability for the Individual and Small Group Health Insurance Markets in 2021“, visit the Analysis Briefs library on Mark Farrah Associates’ website.

About Mark Farrah Associates (MFA)

MFA is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Committed to simplifying analysis of health insurance business, our products include: Health Coverage Portal™, Medicare Business Online™, Medicare Benefits Analyzer™, County Health Coverage™, Health Plans USA™ and 5500 Employer Health Plus. Follow us on LinkedIn!

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email to the “Subscribe to MFA Briefs” section at the bottom of this page.

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Bulgaria’s high out-of-pocket payments for health care undermines progress towards universal health coverage

Bulgaria has a high incidence of catastrophic health spending compared to other European countries. A new report by WHO/Europe launched today at the Bulgarian parliament reveals that in 2018, 1 in 5 households incurred out-of-pocket payments that exceeded their capacity to pay for health care by at least 40%. Catastrophic health spending may mean a household can no longer afford to meet other basic needs, such as food, housing and electricity.

People paying out of pocket for outpatient medicines is the main driver of catastrophic health spending in Bulgaria. This kind of spending affects poorer households, older people and people living in rural areas the most, and it has increased over time, notes the new report ‘Can people afford to pay for health care? New evidence on financial protection in Bulgaria’.

Although the country has made progress in some areas, out-of-pocket payments accounted for 39% of spending on health in 2019, far above the European Union (EU) average of 21%, says the report.

“Bulgaria’s heavy reliance on out-of-pocket payments for health care is a challenge to universal health coverage – the idea that everyone should be able to use quality health services without experiencing financial hardship,” said Tamás Evetovits, Head of the WHO Barcelona Office for Health Systems Financing. “The report recommends focusing on ways to ensure the National Health Insurance Fund covers the whole population and that it makes exemptions for people who cannot afford to pay co-payments for medicines and other health services.”

“Bulgaria has taken concrete steps to improve access to health care and reduce financial hardship for people using health services, but important gaps in health coverage remain, particularly for households with low incomes,” said Antoniya Dimova, Dean of the Faculty of Public Health at Medical University-Varna and the report’s lead author.

“This new analysis

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Know Your Rights: Reproductive Health Care

Reproductive health care, including access to birth control and safe and legal abortion care, is an essential part of your health and well-being. While Roe v. Wade was overturned, abortion remains legal in many states, and other reproductive health care services remain protected by law. The US Department of Health and Human Services (HHS) is committed to providing you with accurate and up-to-date information about access to and coverage of reproductive health care and resources. Our goal is to make sure you have appropriate information and support.

Your Reproductive Rights:

Below you will find information on your right to access care and have it covered by your insurance or other health care coverage if you have it, where to go if you don’t have coverage, and how to get information if you don’t know .

Most health coverage – whether you have public (eg, Medicaid) or private health coverage (eg, coverage through the Affordable Care Act Marketplace or through your employer) – covers family planning counseling, birth control and other preventive services at no cost to you.

Your Right to Birth Control

Under the Affordable Care Act, most health plans are required to provide you with birth control and family planning counseling with no out-of-pocket costs. This includes:

  • Hormonal methods, like birth control pills and vaginal rings
  • Implanted devices, like intrauterine devices (IUDs)
  • Emergency contraception, like Plan B® and ella®
  • Barrier methods, like diaphragms and sponges
  • Patient education and counseling
  • Sterilization procedures

To learn more about birth control coverage requirements for different types of health plans, visit here.


Your Right to Access Abortion Services

Following the Supreme Court decision to overturn Roe v. Wade, access to abortion will depend on the state you live in even more than before.

  • Medication abortion has been approved by the FDA since 2000
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