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Small and medium-sized health plans represent 83 percent of market

Medicare Advantage, managed Medicaid and provider-sponsored plans, represent the bulk of the SMB market.

Susan Morse, Managing Editor

Small and medium-sized health plans that cover fewer than 500,000 lives represent 83 percent of all coverage in the United States, according to an Edifecs study.

Small and medium businesses makeup 409 of the country's 493 health insurance plans.


The study sheds light into the market's growth, consolidation and competitive landscape, according to Mary Swaykus, senior analyst, Product Marketing, at Edifecs and the paper's author.  It shows where the market is heading.


A lot of the plans are relatively new, with Medicare Advantage the growing trend. Thirty-five percent of small and medium businesses offer a Medicare Advantage plan.

Another 35 percent offer Medicaid, with 26 percent of that business in managed Medicaid.

Healthcare reform is driving the managed Medicaid business, Swaykus said. This drive towards smart costs, what is essentially value-based care, is a way for insurers to understand what they're paying for.


Of the estimated 216 provider-sponsored health plans, 94 percent fall into the small and medium business category.

Provider-sponsored plans represent more than half, 53 percent of the SMB market.

Eighty-seven percent of small and medium-sized plans offer some line of government business.

Thirty-three percent take on commercial risk.

Of the nation's estimated 493 health plans, 100 cover fewer than 500 lives.

Twitter: @SusanJMorse
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