U.S. Health Insurance Industry | 2020 Annual Results
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© 2021 National Association of Insurance Commissioners
U.S. Health Insurance Industry Analysis Report
HEALTH INDUSTRY OVERVIEW
Table 1 below provides a 10-year snapshot of the U.S. Health insurance
industry’s aggregate financial results for health entities who file with the
NAIC on the health annual statement blank. The number of Health insurers
filing the health statement type with the NAIC increased to 1,096 from 1,031
in 2019. The health insurance industry continued its tremendous growth
trend as it experienced a significant increase in net earnings to $31 billion
and an increase in the profit margin to 3.8% in 2020 compared to net
earnings of $22 billion and a profit margin of 3% in 2019. The combined ratio
decreased modestly to 97% from 97.6%.
Notable items as compared to 2019 include the following:
Net earned premium increased 11% ($81.2 billion).
Hospital & medical expenses increased 6.6% ($42 billion).
Aggregated loss ratio decreased to 82.6%.
Administrative expenses increased 25.3% ($22.2 billion).
Capital and surplus increased 12.6% ($19.7 billion)
A&H earned premium increased 7% ($67.2 billion).
(For insurers filing the A&H Policy Experience Exhibit on the life/
A&H, health, and property/casualty financial statements)
Impact of COVID-19 on Health Insurance Industry
(In Millions, Except PMPM)
Chg. 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011
Operations
Direct Written Premium
8.3%
$824,728
$761,738
$716,190
$668,521
$638,259
$593,403
$533,083
$459,274
$443,537
$418,482
Net Earned Premium
11.0%
$816,208
$734,993
$708,473
$664,107
$631,656
$587,374
$526,852
$450,737
$433,211
$409,291
Net Investment Income Earned
(17.9)%
$4,997
$6,083
$5,146
$4,798
$3,331
$3,250
$3,229
$3,152
$3,154
$3,245
Underwriting Gain/(Loss)
86.7%
$32,970
$17,656
$21,423
$188,358
$9,918
$6,438
$6,618
$9,637
$11,675
$14,763
Net Income/Loss
41.6%
$31,385
$22,168
$23,142
$16,060
$7,194
$3,672
$5,661
$9,978
$11,744
$13,909
Total Hospital & Medical Exp
6.6%
$674,426
$632,412
$598,130
$568,576
$541,886
$505,506
$450,823
$389,206
$371,947
$346,059
Loss Ratio
(3.2) Pts.
82.6%
85.8%
84.0%
85.4%
85.4%
85.6%
85.3%
85.8%
85.7%
84.5%
Administrative Expenses
25.3%
$109,750
$87,596
$92,628
$78,499
$82,633
$78,712
$71,538
$54,705
$51,221
$48,682
Admin Expense Ratio
1.5 Pts.
13.4%
11.9%
13.0%
11.8%
13.0%
13.3%
13.5%
12.1%
11.8%
11.9%
Combined Ratio
(1.6) Pts.
96.0%
97.6%
97.0%
97.2%
98.4%
98.9%
98.8%
97.9%
97.3%
96.4%
Profit Margin
0.8 Pts.
3.8%
3.0%
3.2%
2.4%
1.1%
0.6%
1.1%
2.2%
2.7%
3.4%
Net Premium PMPM
6.0%
$284
$268
$261
$248
$241
$232
$221
$212
$205
$204
Claims PMPM
2.2%
$236
$231
$220
$213
$207
$199
$189
$183
$177
$173
Cash Flow from Operations
124.3%
$55,347
$24,674
$17,046
$25,435
$12,266
$6,600
$6,273
$8,120
$13,203
$15,399
Enrollment
3.9%
240
231
225
221
218
213
204
178
177
168
Capital and Surplus
Capital & Surplus
12.6%
$175,596
$155,944
$151,793
$137,686
$122,392
$115,561
$112,193
$111,140
$103,041
$94,642
Return on Equity (ROE)
3.6 Pts.
18.5%
14.9%
15.8%
11.9%
6.1%
3.7%
5.7%
10.0%
12.4%
15.5%
Assets
Net Invested Assets
22.1%
$278,475
$228,100
$217,909
$210,825
$189,241
$177,180
$169,991
$163,439
$155,331
$145,706
Net Admitted Assets
16.7%
$375,598
$321,761
$305,218
$289,601
$268,386
$253,277
$238,913
$214,328
$201,801
$188,664
Net Inv Inc & Realized Gain/(Loss)
(14.7)%
$6,585
$7,718
$5,175
$5,438
$4,320
$4,165
$4,832
$4,479
$4,417
$4,249
Investment Yield
(0.7) Pts.
2.0%
2.7%
2.4%
2.4%
1.8%
1.9%
1.9%
2.0%
2.1%
2.3%
Number of Companies Filed
1,096
1,031
1,010
981
967
958
943
926
880
857
Table 1
Health Entities as of December 31, 2020
Note: Aggregate results include only health entities who file annual health statements with the NAIC.
Inside the Report Page No.
Industry Overview ................................... 1
Underwriting Results ............................... 2
Analysis of Operations by LOB ................ 3
Enrollment and Premium Revenues ........ 9
Cash Flow and Liquidity ......................... 11
Capital and Surplus ................................ 12
Accident and Health .............................. 23
857
880
926
943
949
967
981
1,010
1,031
1,096
'11 '12 '13 '14 '15 '16 '17 '18 '19 '20
Health Entities Filing to the NAIC
U.S. Health Insurance Industry | 2020 Annual Results
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© 2021 National Association of Insurance Commissioners
UNDERWRITING RESULTS
Figure 1 illustrates the profitability trend for the health
insurance industry and the increase in both net earnings
and profit margin. The significant increase in the industry’s
underwriting results can be attributed to an 11% ($81.2
billion) increase in net earned premium to $816.2 billion.
However, the industry partially offset this increase with a
6.6% ($42 billion) increase in total hospital and medical
expenses to $674.4 billion, a 25.3% ($22.2 billion) increase
in claims adjustment expenses and general administrative
expenses to $110 billion. Administrative expenses alone
increased 32.6% ($20.6 billion) to $84 billion due primarily
to the return of the health insurer fee (HIF) which was
expensed in full in the first quarter of 2020 at approximately
$15.5 billion. Health insurers then pass on the HIF to
policyholders via premiums. The industry also reported an
18% ($1.1 billion) decrease in net investment income
earned. The decrease can be attributed to a $752 million decrease in interest income from short-term investments. The
Federal Reserve cut interest rates to 0.25% as the COVID-19 Pandemic disrupted economic activities during 2020.
Figure 2 illustrates the increase in total hospital and medical benefits compared to earned premium. For 2020, the industry
reported a decrease in the combined ratio to 96% due to a 3 basis point decrease in the aggregated loss ratio to 83%
partially offset by the aforementioned increase in administrative expenses.
Table 2, starting on the next page, provides an analysis of operations by line of business for 2020. In terms of dollar impact,
the comprehensive hospital and medical ($12 billion), Medicare ($11 billion) and Medicaid ($7 billion) lines of business
were the most profitable. Subsequently, Figures 3 through 10 on pages 6 through 9, illustrate underwriting results, earned
premium, and total hospital and medical expenses in relation to loss ratios by line of business.
Figure 1
Net Income & Profit Margin
U.S. Health Insurance Industry | 2020 Annual Results
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© 2021 National Association of Insurance Commissioners
Despite the CDC reporng nearly 33 million COVID-19 cases naonwide, as noted above, the health industry reported only
a 7% increase in benefit claims incurred. This is consistent with prior year-over-year changes. However, it is important to
note, that offseng factors appear to have reduced the overall financial impact to insurers such as reduced costs related
to cancelled or delayed medical treatments, procedures, and ulizing other non-emergency health benefits. These
offseng factors are also evident in the decreases in the loss raos by line of business as included in Table 2 below.
However, going forward, there is the potenal that delayed treatments could lead to worsening health condions,
resulng in escalated claims expenses. There is also the potenal that Medicare/Medicare Advantage, and Medicaid
writers as well as comprehensive writers serving older and higher risk populaons could be adversely affected.
Comprehensive
Hospital & Medical
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$242,290
$235,482
$240,595
$230,831
$222,273
$215,385
$207,534
$192,420
$191,446
$191,945
Total Hospital & Medical Exp
$194,772
$195,154
$192,884
$191,717
$191,139
$184,916
$175,179
$163,736
$163,346
$160,206
Claims Adj. Expenses
$7,954
$7,740
$7,797
$7,679
$7,381
$7,413
$7,475
$7,167
$6,990
$6,764
General Admin. Expenses
$28,445
$23,394
$27,217
$23,236
$26,382
$26,833
$25,852
$18,842
$18,131
$18,365
Total Underwriting Deductions
$231,717
$226,283
$227,850
$222,256
$223,898
$219,054
$209,078
$189,712
$188,553
$185,187
Net Underwriting Gain/(Loss)
$12,154
$8,857
$12,972
$9,200
($966)
($2,017)
($70)
$4,023
$4,159
$6,987
Loss Ratio
80.1%
83.0%
80.1%
82.7%
85.3%
85.2%
84.1%
84.5%
84.8%
83.3%
Admin Expense Ratio
14.9%
13.2%
14.5%
13.4%
15.1%
15.8%
15.9%
13.4%
13.0%
13.1%
Combined Ratio
95.0%
96.2%
94.6%
96.0%
100.4%
100.9%
100.0%
97.9%
97.8%
96.4%
Net Premium PMPM
$487
$460
$460
$424
$388
$363
$347
$319
$309
$303
Claims PMPM
$392
$384
$337
$352
$319
$310
$294
$271
$264
$253
Enrollment
41
42
43
44
46
49
49
50
52
53
Medicare Supplement
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$11,455
$10,940
$10,234
$10,072
$9,568
$9,156
$8,690
$8,162
$8,088
$7,811
Total Hospital & Medical Exp
$8,385
$8,789
$8,061
$7,799
$7,640
$7,368
$6,910
$6,457
$6,460
$6,336
Claims Adj. Expenses
$502
$547
$486
$483
$439
$419
$379
$399
$385
$397
General Admin. Expenses
$1,666
$1,500
$1,267
$1,299
$1,193
$1,189
$1,077
$948
$937
$937
Total Underwriting Deductions
$10,616
$10,952
$9,886
$9,637
$9,320
$9,021
$8,157
$7,847
$7,815
$7,608
Net Underwriting Gain/(Loss)
$809
($14)
$342
$444
$271
$119
$564
$304
$258
$195
Loss Ratio
73.9%
81.4%
79.5%
77.9%
80.2%
81.1%
76.9%
79.8%
80.4%
80.4%
Admin Expense Ratio
19.0%
18.7%
17.1%
17.7%
17.0%
17.6%
16.7%
16.5%
16.4%
17.1%
Combined Ratio
92.9%
100.1%
96.7%
95.6%
97.2%
98.7%
93.5%
96.3%
96.8%
97.5%
Net Premium PMPM
$199
$199
$197
$195
$185
$181
$181
$183
$180
$177
Claims PMPM
$147
$162
$157
$152
$148
$147
$139
$146
$145
$142
Enrollment
5
5
4
4
4
4
4
4
4
4
Analysis of Operations by Lines of Business
Table 2
U.S. Health Insurance Industry | 2020 Annual Results
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© 2021 National Association of Insurance Commissioners
Dental
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$13,511
$13,754
$13,567
$12,941
$12,685
$12,480
$11,752
$10,449
$9,995
$9,327
Total Hospital & Medical Exp
$9,739
$11,035
$10,647
$10,158
$9,955
$9,761
$9,132
$8,059
$7,789
$7,389
Claims Adj. Expenses
$737
$691
$658
$554
$513
$489
$428
$384
$407
$412
General Admin. Expenses
$2,136
$1,821
$1,928
$1,765
$1,829
$1,821
$1,685
$1,282
$1,206
$1,091
Total Underwriting Deductions
$12,606
$13,553
$13,235
$12,477
$12,295
$12,071
$11,241
$9,722
$9,403
$8,895
Net Underwriting Gain/(Loss)
$1,384
$731
$711
$821
$790
$749
$758
$856
$703
$532
Loss Ratio
69.6%
77.3%
76.4%
76.4%
76.1%
76.1%
76.1%
76.2%
77.1%
78.4%
Admin Expense Ratio
20.5%
17.6%
18.5%
17.4%
17.9%
18.0%
17.6%
15.7%
16.0%
15.9%
Combined Ratio
90.1%
94.9%
94.9%
93.8%
94.0%
94.2%
93.7%
91.9%
93.0%
94.4%
Net Premium PMPM
$26
$27
$27
$25
$25
$25
$25
$26
$25
$24
Claims PMPM
$19
$22
$21
$19
$20
$20
$20
$20
$19
$19
Enrollment
42
42
42
44
42
41
40
34
33
32
Vision
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$3,848
$3,831
$3,624
$2,651
$2,469
$2,300
$2,148
$1,694
$1,606
$1,500
Total Hospital & Medical Exp
$2,734
$3,000
$2,893
$2,050
$1,927
$1,832
$1,703
$1,364
$1,312
$1,223
Claims Adj. Expenses
$77
$71
$67
$58
$51
$46
$37
$32
$30
$25
General Admin. Expenses
$527
$497
$511
$415
$405
$388
$369
$234
$220
$211
Total Underwriting Deductions
$3,338
$3,568
$3,471
$2,520
$2,378
$2,272
$2,109
$1,629
$1,559
$1,463
Net Underwriting Gain/(Loss)
$733
$438
$332
$311
$251
$182
$178
$181
$182
$149
Loss Ratio
67.2%
74.9%
76.1%
72.3%
73.1%
74.9%
74.5%
75.3%
75.2%
76.1%
Admin Expense Ratio
14.8%
14.2%
15.2%
16.7%
17.4%
17.7%
17.7%
14.7%
14.4%
14.7%
Combined Ratio
82.0%
89.1%
91.3%
89.0%
90.5%
92.6%
92.2%
90.0%
89.5%
90.8%
Net Premium PMPM
$9
$9
$9
$7
$7
$6
$6
$6
$6
$5
Claims PMPM
$6
$7
$7
$5
$5
$5
$5
$5
$4
$4
Enrollment
36
36
35
33
31
30
29
25
25
23
FEHBP
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$40,456
$38,744
$37,529
$37,796
$37,868
$36,313
$34,138
$32,058
$31,601
$31,266
Total Hospital & Medical Exp
$36,123
$36,669
$35,246
$34,643
$34,005
$33,031
$31,622
$30,234
$29,578
$28,398
Claims Adj. Expenses
$999
$911
$972
$870
$854
$809
$782
$782
$704
$695
General Admin. Expenses
$2,168
$1,485
$1,955
$1,355
$2,013
$2,025
$1,835
$1,112
$1,078
$1,042
Total Underwriting Deductions
$39,291
$39,064
$38,172
$36,866
$36,854
$35,859
$34,251
$32,132
$31,358
$30,138
Net Underwriting Gain/(Loss)
$563
$108
$293
$158
$541
$413
$376
$247
$252
$252
Loss Ratio
90.6%
93.6%
91.6%
93.6%
90.9%
91.0%
91.4%
93.4%
93.6%
93.5%
Admin Expense Ratio
7.9%
6.1%
7.6%
6.0%
7.7%
7.8%
7.6%
5.9%
5.6%
5.7%
Combined Ratio
98.6%
99.7%
99.2%
99.6%
98.6%
98.9%
98.9%
99.2%
99.2%
99.2%
Net Premium PMPM
$369
$371
$415
$399
$409
$406
$403
$369
$357
$356
Claims PMPM
$335
$348
$381
$374
$373
$370
$369
$346
$334
$333
Enrollment
9
9
8
8
8
7
7
7
7
7
Table 2
Analysis of Operations by Lines of Business
U.S. Health Insurance Industry | 2020 Annual Results
5 | P a g e
© 2021 National Association of Insurance Commissioners
Table 2
Analysis of Operations by Lines of Business
Medicare
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$249,351
$209,661
$192,548
$171,532
$159,507
$146,804
$131,029
$105,568
$97,810
$90,958
Total Hospital & Medical Exp
$205,418
$179,337
$164,541
$146,837
$135,243
$127,385
$113,800
$91,644
$84,119
$77,532
Claims Adj. Expenses
$8,337
$7,432
$6,424
$5,831
$5,118
$4,766
$4,071
$3,184
$2,705
$2,282
General Admin. Expenses
$23,341
$16,042
$17,597
$13,493
$14,456
$13,144
$11,684
$8,399
$7,696
$7,096
Total Underwriting Deductions
$237,276
$203,124
$188,474
$166,258
$154,519
$145,377
$129,762
$103,325
$94,594
$86,952
Net Underwriting Gain/(Loss)
$11,377
$6,818
$4,435
$5,225
$4,929
$1,219
$1,448
$2,339
$4,424
$4,083
Loss Ratio
82.7%
85.6%
85.2%
85.7%
84.6%
87.0%
86.9%
86.8%
85.0%
85.2%
Admin Expense Ratio
12.7%
11.2%
12.5%
11.3%
12.3%
12.2%
12.0%
11.0%
10.5%
10.3%
Combined Ratio
95.4%
96.8%
97.7%
97.0%
96.9%
99.2%
98.9%
97.8%
95.5%
95.5%
Net Premium PMPM
$1,083
$990
$970
$939
$923
$891
$901
$909
$919
$941
Claims PMPM
$897
$848
$828
$805
$781
$775
$783
$789
$791
$802
Enrollment
25
18
17
15
15
14
12
10
9
8
Medicaid
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$234,853
$204,595
$190,505
$180,994
$170,461
$148,609
$115,661
$88,067
$77,730
$65,653
Total Hospital & Medical Exp
$199,032
$182,883
$167,308
$160,899
$148,585
$127,938
$98,905
$77,470
$68,810
$56,259
Claims Adj. Expenses
$6,373
$6,103
$5,751
$5,388
$5,134
$4,872
$3,637
$2,957
$2,283
$1,900
General Admin. Expenses
$22,086
$16,497
$17,218
$14,112
$15,520
$13,073
$10,322
$7,168
$6,622
$6,040
Total Underwriting Deductions
$227,342
$205,305
$190,142
$180,540
$169,393
$145,857
$113,074
$87,606
$77,836
$64,225
Net Underwriting Gain/(Loss)
$6,770
$138
$1,066
$1,033
$1,405
$3,635
$2,235
$1,106
$480
$1,650
Loss Ratio
85.0%
88.9%
87.4%
88.7%
87.1%
85.6%
86.0%
87.3%
88.0%
85.4%
Admin Expense Ratio
12.2%
11.0%
12.0%
10.7%
12.1%
12.0%
12.1%
11.4%
11.4%
12.1%
Combined Ratio
97.1%
99.9%
99.4%
99.4%
99.2%
97.6%
98.1%
98.8%
99.4%
97.5%
Net Premium PMPM
$461
$389
$368
$387
$360
$339
$317
$292
$266
$253
Claims PMPM
$394
$348
$323
$344
$315
$291
$274
$257
$236
$217
Enrollment
46
43
43
39
40
38
35
26
25
23
Other Health
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
(In Millions, Except PMPM)
Net Earned Premium
$20,434
$17,977
$18,328
$17,271
$16,773
$16,269
$15,792
$12,145
$13,181
$10,701
Total Hospital & Medical Exp
$18,222
$15,545
$15,171
$14,473
$13,392
$13,275
$13,569
$10,232
$10,549
$8,711
Claims Adj. Expenses
$822
$782
$391
$645
$438
$772
$1,045
$790
$778
$793
General Admin. Expenses
$3,374
$1,868
$2,060
$1,245
$844
$618
$758
$886
$972
$546
Total Underwriting Deductions
$22,763
$18,218
$17,581
$16,378
$14,717
$14,600
$15,400
$11,912
$12,301
$10,060
Net Underwriting Gain/(Loss)
($748)
$640
$1,319
$1,576
$2,666
$2,128
$944
$632
$1,155
$956
Loss Ratio
84.3%
82.6%
80.1%
80.7%
77.3%
79.0%
83.2%
81.6%
78.4%
79.2%
Admin Expense Ratio
19.1%
14.1%
13.0%
10.5%
7.4%
8.3%
11.0%
13.4%
13.0%
12.2%
Combined Ratio
103.4%
96.6%
93.0%
91.2%
84.7%
87.3%
94.2%
95.0%
91.4%
91.3%
Net Premium PMPM
$46
$42
$45
$44
$44
$47
$49
$44
$49
$48
Claims PMPM
$42
$36
$37
$37
$35
$38
$42
$38
$40
$39
Enrollment
37
36
34
33
32
29
28
23
22
19
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© 2021 National Association of Insurance Commissioners
ENROLLMENT AND PREMIUM REVENUES
Enrollment increased 4% (9 million) to 240 million. The enrollment increase is reflected in a 37% (6.6 million) increase in
Medicare, a 4.8% (2.1 million) increase in the Medicaid line of business, and a 3.1% (1.1 million) increase in Medicare Part
D Prescription Drug coverage. However, the industry also reported a 4.3% (1.3 million) decrease in the group
comprehensive line of business. Figure 11 illustrates the enrollment trend for the four largest revenue generating lines of
business for the past 10 years. Despite the COVID-19 pandemic, the industry still experienced growth in Medicaid and
Medicare. Increased unemployment rates caused by the pandemic have also disrupted health coverage for millions of
people as most working-age adults receive health insurance coverage for themselves and their families through their
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employer. However, many of those who lost job-based health insurance coverage would possibly qualify for Medicaid or
had the opportunity to purchase individual health coverage through the exchange or other managed care health providers.
The shi in business concentration can also be attributed to an increase in the number of insureds becoming eligible for
either Medicare or Medicaid as evidenced by increases in enrollment in these lines. A certain amount of the Medicaid
enrollment increase is likely due to the continued expansion of Medicaid programs in certain states.
Direct written premium increased 8.3% ($63 billion) to $824.7 billion. Figure 12 illustrates the mix of direct written
premium for 2020. During the last several years, there has been a gradual shift in the allocation of premium between the
lines of business. In comparison to 2019, direct comprehensive medical decreased to 29.8% of total premium from 31.7%,
while Medicare increased to 30.4% from 28.6% and Medicaid increased modestly to 28.6% from 27.7%.
Health entities reported premium per member per month (PMPM) of $284 and claims PMPM of $236 for 2020. Figure 13
illustrates a 10-year trend on an aggregate basis of the increase in premium PMPM vs claims PMPM and the resulting
spread. In referring back to Table 2, it is apparent the Medicare line of business is the most expensive at over $1 thousand
per member month but also reported one of the highest net underwriting gains with a spread of premium PMPM over
claims PMPM of $186 and an aggregate underwriting gain of $11 billion.
Table 3 on page 11, provides direct written premium by line of business for the last 10 years. The largest increases in
written premium from 2019 are most evident in a 13% ($29 billion) increase in Medicare, a 12% ($26 billion) increase in
Medicaid, an 8% ($6 billion) increase in the individual comprehensive line of business, and a 3% ($1 billion) increase in
Federal Employee Health Benefit Plan. The overall premium growth can be attributed to increases in enrollment, and
premium rates. In a 10-year comparison to 2011, the most significant increases in written premium are in the Medicaid
($168 billion), Medicare ($157 billion), individual comprehensive ($56 billion), Federal Employee Health Benefit Plan,
Dental ($4 billion), Medicare Supplement ($4 billion), and Medicare Part D ($10 billion) lines of business. The group
comprehensive Line of business decreased ($10 billion). Table 4 on pages 13-21 provides a further breakout of written
premium, claims, loss ratio, and enrollment by state and by line of business. The states high-lighted in yellow are the five
largest writers in that particular line of business.
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© 2021 National Association of Insurance Commissioners
(In Millions)
Chg. 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011
Individual Comprehensive
7.6%
$78,232
$72,722
$76,017
$68,660
$63,310
$55,292
$43,388
$24,713
$23,389
$22,624
Group Comprehensive
(0.5)%
$165,839
$166,717
$165,339
$162,605
$160,574
$162,297
$166,375
$172,220
$174,959
$175,843
Medicare Supplement
4.3%
$12,041
$11,546
$10,807
$10,596
$10,061
$9,609
$9,105
$8,531
$8,439
$8,138
Vision
(1.3)%
$2,619
$2,654
$2,561
$2,410
$2,255
$2,099
$1,952
$1,635
$1,550
$1,448
Dental
(3.3)%
$13,579
$14,048
$13,855
$14,090
$13,074
$12,561
$12,017
$10,046
$10,113
$9,587
FEHBP
3.4%
$42,639
$41,218
$38,942
$37,860
$37,923
$36,356
$34,140
$32,061
$31,669
$31,209
Medicare
13.3%
$248,793
$219,554
$192,253
$170,413
$158,908
$147,273
$128,890
$105,917
$99,981
$91,519
Medicaid
12.3%
$234,421
$208,695
$192,181
$180,535
$170,234
$149,148
$115,977
$89,069
$78,535
$65,994
Other Health
4.8%
$21,144
$20,170
$18,883
$18,142
$18,569
$17,349
$16,900
$14,111
$14,194
$11,373
Table 3
Direct Written Premium by Lines of Business
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© 2021 National Association of Insurance Commissioners
CASH FLOW AND LIQUIDITY
The health insurance industry showed a significant increase in operating cash flow to $55.3 billion in 2020 as compared to
operating cash flow of $24.7 billion in 2019. The considerable increase in positive cash flow is due primarily to a 9.6% ($72
billion) increase in premiums collected. However, this was partially offset by a 4% ($22.4 billion) increase in benefits and
loss-related payments and a 16.7% ($15 billion) decrease in commissions and expenses paid.
As illustrated in Figure 14, liquid assets and receivables increased 18% ($52 billion) to $332 billion in 2020 from $280 billion
in the prior year end. This was partially offset by a 20% ($31 billion) increase in current liabilities to $185 billion from $155
billion. This resulted in an unfavorable decrease in the ratio of liquid assets and receivables to current liabilities to 179%
from 181%.
CAPITAL AND SURPLUS
Health entities reported a 12.6% ($20 billion) increase in capital and surplus to $176 billion from $156 billion at Dec. 31,
2019 as illustrated in Figure 15. The increase is due primarily to net income of $31 billion, a $3 billion increase in unrealized
capital gains, and paid-in surplus of $3.4 billion. These items were partially offset by dividends of $14 billion paid to
stockholders, and a $1.7 billion increase in non-admitted assets.
Figure 15
Capital & Surplus, Net Income & Dividends Paid
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($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019 % Chg.
Alabama
$1,527
$1,368
11.7%
$1,194
$1,103
8.3%
78.2%
80.8%
(2.6)
179,380
170,702
5.1%
Alaska
$160
$156
2.6%
$182
$162
12.0%
106.5%
109.7%
(3.2)
17,098
16,781
1.9%
Arizona
$1,205
$1,111
8.4%
$839
$785
6.9%
69.5%
72.6%
(3.1)
161,951
163,322
(0.8)%
Arkansas
$1,650
$1,433
15.1%
$1,185
$1,152
2.9%
71.8%
80.4%
(8.5)
358,932
312,876
14.7%
California
$280
$398
(29.5)%
$204
$337
(39.4)%
72.8%
84.7%
(11.9)
45,224
69,598
(35.0)%
Colorado
$1,321
$1,351
(2.2)%
$938
$1,057
(11.3)%
71.2%
78.5%
(7.3)
210,731
191,361
10.1%
Connecticut
$958
$867
10.4%
$740
$702
5.5%
77.3%
80.9%
(3.6)
108,177
105,731
2.3%
Delaware
$251
$228
10.0%
$168
$140
19.6%
69.6%
64.1%
5.5
25,069
22,483
11.5%
District of Columbia
$200
$169
18.3%
$185
$168
9.8%
92.4%
99.6%
(7.2)
35,812
30,094
19.0%
Florida
$12,303
$11,554
6.5%
$9,453
$8,333
13.4%
76.6%
73.5%
3.1
1,973,244
1,895,280
4.1%
Georgia
$3,194
$2,906
9.9%
$2,483
$2,256
10.1%
84.3%
77.7%
6.7
544,215
432,970
25.7%
Hawaii
$313
$232
34.9%
$198
$199
(0.5)%
63.3%
85.8%
(22.5)
36,310
33,944
7.0%
Idaho
$777
$665
16.9%
$444
$551
(19.4)%
59.7%
82.9%
(23.2)
93,668
112,353
(16.6)%
Illinois
$2,435
$2,638
(7.7)%
$2,181
$2,040
0.0%
82.7%
84.6%
(1.8)
351,189
355,669
(1.3)%
Indiana
$609
$544
12.0%
$468
$448
4.5%
76.9%
82.4%
(5.5)
120,256
121,527
(1.0)%
Iowa
$695
$711
(2.3)%
$507
$513
(1.1)%
72.3%
75.4%
(3.2)
113,527
108,154
5.0%
Kansas
$448
$360
24.5%
$265
$259
2.4%
59.2%
72.0%
(12.8)
82,266
75,437
9.1%
Kentucky
$666
$687
(3.0)%
$502
$526
(4.6)%
75.6%
76.6%
(1.0)
105,355
107,519
(2.0)%
Louisiana
$1,032
$878
17.5%
$724
$759
(4.6)%
70.4%
86.6%
(16.3)
134,213
134,342
(0.1)%
Maine
$438
$529
(17.3)%
$341
$385
(11.3)%
80.4%
74.1%
6.3
58,508
61,081
(4.2)%
Maryland
$1,382
$1,358
1.7%
$1,366
$1,233
10.8%
97.0%
93.1%
3.9
262,548
234,844
11.8%
Massachusetts
$2,531
$2,466
2.7%
$2,354
$2,283
3.1%
92.1%
93.7%
(1.5)
386,776
433,287
(10.7)%
Michigan
$1,813
$1,863
(2.7)%
$1,349
$1,381
(2.3)%
74.0%
74.1%
(0.1)
315,166
306,088
3.0%
Minnesota
$1,085
$766
41.6%
$686
$700
(1.9)%
63.1%
91.7%
(28.6)
153,127
145,078
5.5%
Mississippi
$936
$810
15.5%
$707
$638
10.9%
76.8%
78.7%
(1.9)
163,886
151,674
8.1%
Missouri
$961
$828
16.1%
$673
$642
4.8%
69.9%
77.5%
(7.6)
185,608
162,971
13.9%
Montana
$335
$385
(12.8)%
$291
$296
(1.5)%
82.9%
82.8%
0.1
48,277
46,776
3.2%
Nebraska
$848
$918
(7.7)%
$642
$661
(3.0)%
75.7%
72.0%
3.7
83,928
90,048
(6.8)%
Nevada
$564
$595
(5.3)%
$445
$439
1.2%
78.9%
73.7%
5.1
115,084
108,974
5.6%
New Hampshire
$268
$264
1.3%
$179
$190
(5.7)%
67.9%
72.6%
(4.7)
49,094
46,130
6.4%
New Jersey
$2,078
$1,892
9.8%
$1,856
$1,780
4.3%
89.5%
95.8%
(6.3)
331,277
319,799
3.6%
New Mexico
$202
$286
(29.4)%
$148
$238
(38.1)%
75.9%
84.1%
(8.3)
33,610
48,220
(30.3)%
New York
$1,667
$1,911
(12.8)%
$1,400
$1,676
(16.4)%
82.2%
87.7%
(5.5)
307,688
343,866
(10.5)%
North Carolina
$4,273
$4,196
1.9%
$3,375
$3,264
3.4%
79.0%
77.8%
1.2
507,348
477,578
6.2%
North Dakota
$229
$262
(12.7)%
$201
$228
(11.9)%
87.7%
86.8%
0.8
40,695
43,027
(5.4)%
Ohio
$1,471
$1,525
(3.6)%
$1,194
$1,195
(0.0)%
81.2%
78.3%
2.9
225,941
227,947
(0.9)%
Oklahoma
$1,099
$1,181
(7.0)%
$1,027
$859
19.5%
88.0%
77.4%
10.6
158,516
151,521
4.6%
Oregon
$1,297
$1,155
12.3%
$1,016
$1,046
(2.8)%
78.5%
90.5%
(12.1)
168,529
165,561
1.8%
Pennsylvania
$3,848
$3,470
10.9%
$2,461
$2,612
0.0%
63.7%
77.5%
(13.7)
568,630
593,963
(4.3)%
Rhode Island
$237
$247
(4.1)%
$184
$193
(4.8)%
77.7%
78.3%
(0.6)
41,208
41,726
(1.2)%
South Carolina
$1,670
$1,704
(2.0)%
$1,257
$1,165
7.9%
74.9%
70.0%
4.9
243,464
225,296
8.1%
South Dakota
$407
$348
16.8%
$307
$297
3.3%
75.5%
85.3%
(9.9)
49,758
50,582
(1.6)%
Tennessee
$1,135
$1,109
2.4%
$845
$848
(0.4)%
72.8%
81.5%
(8.7)
150,693
156,233
(3.5)%
Texas
$6,511
$6,232
4.5%
$5,731
$5,205
10.1%
88.0%
88.3%
(0.3)
1,343,817
1,245,826
7.9%
Utah
$1,371
$1,171
17.1%
$905
$967
(6.4)%
66.0%
83.1%
(17.1)
226,301
226,987
(0.3)%
Vermont
$258
$230
12.0%
$210
$215
(2.2)%
81.6%
93.3%
(11.8)
31,263
31,643
(1.2)%
Virginia
$1,803
$1,741
3.6%
$1,172
$1,193
(1.8)%
67.9%
69.1%
(1.2)
249,937
219,468
13.9%
Washington
$1,576
$1,618
(2.6)%
$1,192
$1,198
(0.5)%
75.9%
75.3%
0.6
277,267
235,846
17.6%
West Virginia
$289
$241
20.3%
$181
$182
(0.5)%
62.6%
75.7%
(13.1)
18,889
19,484
(3.1)%
Wisconsin
$1,767
$1,815
(2.7)%
$1,399
$1,426
(1.9)%
81.4%
78.6%
2.8
202,951
197,543
2.7%
Wyoming
$305
$302
0.9%
$223
$219
1.8%
70.7%
72.4%
(1.6)
25,938
28,520
(9.1)%
American Samoa
-
-
0.0%
-
-
0.0%
0.0%
0.0%
0.0
-
-
0.0%
Guam
$1
$1
(13.3)%
-
-
0.0%
0.0%
0.0%
0.0
11
8
37.5%
Northern Mariana Islands
$2
$2
(7.6)%
-
-
0.0%
0.0%
0.0%
0.0
2
3
(33.3)%
Puerto Rico
$342
$306
11.8%
$303
$260
16.7%
228.3%
232.7%
(4.3)
205,861
340,327
(39.5)%
U.S. Virgin Islands
$1
$1
(8.4)%
$1
$1
(41.2)%
75.9%
91.0%
(15.1)
229
278
(17.6)%
Aggregate Other Alien
$3,225
$739
336.7%
$48
$65
(25.7)%
1.5%
8.8%
(7.3)
17,140
18,461
(7.2)%
Grand Totals
$78,232
$72,722
7.6%
$58,519
$56,669
3.3%
75.0%
79.6%
(4.6)
11,942,107
11,656,807
2.4%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
ClaimsDirect Written Premium Loss Ratio*
Table 4 - Individual Comprehensive Hospital & Medical
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
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14 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$3,015
$2,868
5.1%
$2,789
$2,618
6.5%
91.8%
92.0%
(0.2)
615,589
609,165
1.1%
Alaska
$300
$292
2.4%
$246
$219
12.5%
81.8%
75.8%
6.0
34,685
32,740
5.9%
Arizona
$1,393
$1,355
2.8%
$1,119
$1,065
5.1%
80.5%
78.4%
2.1
280,646
282,050
(0.5)%
Arkansas
$1,053
$1,122
(6.2)%
$847
$925
(8.5)%
80.3%
82.4%
(2.1)
219,815
239,177
(8.1)%
California
$524
$652
(19.6)%
$411
$554
(25.7)%
81.4%
88.6%
(7.2)
91,722
89,132
2.9%
Colorado
$3,104
$3,160
(1.8)%
$2,607
$2,759
(5.5)%
84.2%
87.4%
(3.2)
540,779
578,544
(6.5)%
Connecticut
$1,776
$1,888
(6.0)%
$1,459
$1,609
(9.3)%
82.2%
85.2%
(3.0)
233,531
259,358
(10.0)%
Delaware
$305
$373
(18.1)%
$235
$284
(17.3)%
80.2%
76.1%
4.1
43,461
49,241
(11.7)%
District of Columbia
$1,470
$1,420
3.5%
$1,146
$1,140
0.5%
78.7%
81.0%
(2.3)
217,795
232,889
(6.5)%
Florida
$9,323
$9,945
(6.3)%
$7,831
$8,561
(8.5)%
83.1%
86.1%
(2.9)
1,387,227
1,500,892
(7.6)%
Georgia
$4,248
$4,317
(1.6)%
$3,804
$3,890
(2.2)%
119.5%
90.1%
29.3
808,172
894,652
(9.7)%
Hawaii
$3,078
$3,155
(2.5)%
$2,666
$2,818
(5.4)%
86.8%
89.5%
(2.7)
646,841
694,073
(6.8)%
Idaho
$1,208
$1,192
1.3%
$1,026
$1,020
0.6%
85.6%
85.4%
0.2
244,870
246,288
(0.6)%
Illinois
$11,002
$10,979
0.2%
$9,753
$9,327
0.0%
88.2%
84.8%
3.4
1,926,906
1,948,114
(1.1)%
Indiana
$1,721
$1,771
(2.8)%
$1,381
$1,479
(6.6)%
80.7%
83.1%
(2.4)
296,736
325,482
(8.8)%
Iowa
$2,116
$2,117
(0.0)%
$1,717
$1,723
(0.3)%
82.0%
81.6%
0.4
380,794
395,501
(3.7)%
Kansas
$534
$547
(2.4)%
$413
$421
(1.8)%
77.0%
76.8%
0.2
164,274
186,497
(11.9)%
Kentucky
$1,873
$1,891
(0.9)%
$1,548
$1,579
(2.0)%
82.9%
83.6%
(0.7)
330,428
350,599
(5.8)%
Louisiana
$2,514
$2,463
2.1%
$2,042
$2,109
(3.2)%
81.3%
85.7%
(4.4)
424,605
446,904
(5.0)%
Maine
$1,155
$1,145
0.9%
$919
$986
(6.8)%
82.2%
86.0%
(3.8)
170,374
183,353
(7.1)%
Maryland
$3,037
$3,057
(0.7)%
$2,410
$2,457
(1.9)%
80.0%
80.9%
(0.9)
531,773
563,986
(5.7)%
Massachusetts
$8,679
$8,758
(0.9)%
$7,014
$7,545
(7.0)%
81.0%
86.4%
(5.4)
1,272,387
1,354,497
(6.1)%
Michigan
$9,108
$9,126
(0.2)%
$7,610
$7,738
(1.7)%
83.9%
84.9%
(1.0)
1,758,041
1,787,807
(1.7)%
Minnesota
$4,217
$4,368
(3.5)%
$3,499
$3,790
(7.7)%
83.0%
86.8%
(3.8)
833,808
915,288
(8.9)%
Mississippi
$899
$862
4.3%
$749
$771
(2.8)%
83.3%
89.4%
(6.1)
187,690
196,332
(4.4)%
Missouri
$2,039
$2,342
(12.9)%
$1,619
$1,965
(17.6)%
79.7%
82.8%
(3.1)
418,038
510,401
(18.1)%
Montana
$485
$453
7.1%
$394
$376
4.8%
81.3%
83.5%
(2.2)
82,808
85,055
(2.6)%
Nebraska
$1,023
$1,006
1.7%
$873
$853
2.4%
85.8%
84.3%
1.5
161,606
166,628
(3.0)%
Nevada
$1,767
$1,761
0.3%
$1,461
$1,402
4.2%
82.4%
79.7%
2.7
365,909
386,906
(5.4)%
New Hampshire
$1,050
$1,066
(1.5)%
$820
$850
(3.5)%
78.6%
79.9%
(1.3)
158,488
162,020
(2.2)%
New Jersey
$5,671
$5,926
(4.3)%
$4,577
$4,924
(7.0)%
81.0%
83.5%
(2.5)
733,330
812,975
(9.8)%
New Mexico
$523
$556
(6.1)%
$432
$466
(7.2)%
83.2%
84.2%
(1.0)
82,302
88,745
(7.3)%
New York
$17,714
$17,569
0.8%
$14,661
$14,847
(1.3)%
82.5%
84.5%
(2.0)
2,407,485
2,540,321
(5.2)%
North Carolina
$2,753
$2,828
(2.7)%
$2,316
$2,363
(2.0)%
84.2%
83.5%
0.6
519,621
542,127
(4.2)%
North Dakota
$1,079
$1,058
2.0%
$932
$959
(2.8)%
86.3%
90.7%
(4.3)
189,122
197,482
(4.2)%
Ohio
$5,054
$4,876
3.7%
$4,139
$4,110
0.7%
81.9%
84.3%
(2.4)
862,585
869,566
(0.8)%
Oklahoma
$1,832
$1,824
0.5%
$1,538
$1,466
5.0%
82.1%
82.0%
0.1
352,703
345,863
2.0%
Oregon
$4,283
$4,229
1.3%
$3,489
$3,710
(6.0)%
81.5%
87.6%
(6.2)
726,460
755,134
(3.8)%
Pennsylvania
$8,502
$8,703
(2.3)%
$7,017
$7,509
0.0%
82.7%
86.2%
(3.6)
1,377,030
1,489,198
(7.5)%
Rhode Island
$771
$806
(4.4)%
$638
$670
(4.8)%
82.7%
83.1%
(0.4)
122,115
130,411
(6.4)%
South Carolina
$1,785
$1,736
2.8%
$1,382
$1,417
(2.5)%
78.0%
82.2%
(4.2)
339,502
365,901
(7.2)%
South Dakota
$698
$678
2.9%
$567
$566
0.2%
81.3%
83.5%
(2.2)
120,148
122,128
(1.6)%
Tennessee
$2,423
$2,519
(3.8)%
$1,992
$2,008
(0.8)%
82.1%
79.9%
2.2
489,717
543,443
(9.9)%
Texas
$9,984
$9,532
4.7%
$8,669
$8,271
4.8%
86.8%
86.8%
(0.0)
1,881,919
1,930,577
(2.5)%
Utah
$1,779
$1,691
5.2%
$1,484
$1,467
1.1%
83.2%
86.6%
(3.4)
392,506
394,410
(0.5)%
Vermont
$342
$386
(11.3)%
$284
$354
(19.9)%
82.8%
91.6%
(8.8)
50,023
61,152
(18.2)%
Virginia
$3,929
$3,905
0.6%
$3,123
$3,213
(2.8)%
80.0%
83.2%
(3.2)
657,124
676,120
(2.8)%
Washington
$5,914
$5,891
0.4%
$4,822
$4,954
(2.7)%
81.5%
84.1%
(2.6)
1,052,913
1,066,258
(1.3)%
West Virginia
$607
$651
(6.8)%
$518
$543
(4.6)%
85.4%
83.5%
1.9
97,083
102,104
(4.9)%
Wisconsin
$4,916
$4,702
4.5%
$4,322
$4,346
(0.6)%
87.9%
92.5%
(4.5)
897,411
871,788
2.9%
Wyoming
$164
$170
(3.5)%
$136
$149
(9.2)%
81.7%
87.8%
(6.2)
24,116
24,735
(2.5)%
American Samoa
$1
$4
(61.1)%
$1
$2
(45.9)%
768.5%
55.3%
713.2
9
9
0.0%
Guam
$34
$53
(35.1)%
$43
$54
(20.7)%
129.8%
106.8%
23.0
9,695
12,460
(22.2)%
Northern Mariana Islands
$4
$4
(3.6)%
$4
$5
(13.5)%
110.3%
125.3%
(15.0)
1,203
2,439
(50.7)%
Puerto Rico
$842
$835
0.9%
$643
$688
(6.6)%
117.4%
127.6%
(10.3)
477,583
356,761
33.9%
U.S. Virgin Islands
$11
$11
0.2%
$7
$7
(5.5)%
62.3%
66.1%
(3.8)
2,030
2,108
(3.7)%
Aggregate Other Alien
$172
$65
163.3%
$2
$2
(13.8)%
1.1%
3.4%
(2.3)
2,775
2,572
7.9%
Grand Totals
$165,839
$166,717
(0.5)%
$138,099
$141,900
(2.7)%
84.0%
85.4%
(1.4)
28,683,793
29,980,358
(4.3)%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Group Comprehensive Hospital & Medical
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
15 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$248
$242
2.5%
$199
$221
(10.3)%
80.9%
93.3%
(12.4)
117,607
123,838
(5.0)%
Alaska
$6
$6
10.4%
$5
$4
1.3%
73.8%
80.4%
(6.7)
2,853
2,727
4.6%
Arizona
$144
$130
10.6%
$98
$97
1.3%
68.1%
74.3%
(6.2)
62,894
55,583
13.2%
Arkansas
$300
$276
8.5%
$220
$234
(6.3)%
73.3%
83.6%
(10.2)
128,607
126,822
1.4%
California
$48
$43
11.4%
$36
$37
(2.0)%
75.8%
86.2%
(10.4)
21,443
20,673
3.7%
Colorado
$89
$80
11.2%
$64
$61
4.9%
72.1%
75.9%
(3.8)
42,831
38,076
12.5%
Connecticut
$157
$140
11.9%
$113
$108
4.6%
72.3%
77.2%
(4.9)
60,712
55,601
9.2%
Delaware
$24
$23
6.5%
$16
$16
(3.4)%
64.2%
70.7%
(6.5)
11,653
10,237
13.8%
District of Columbia
$5
$5
7.3%
$4
$4
0.7%
76.9%
81.9%
(5.0)
2,279
2,203
3.4%
Florida
$537
$516
4.0%
$392
$415
(5.5)%
73.0%
80.4%
(7.3)
200,983
203,583
(1.3)%
Georgia
$220
$196
11.9%
$153
$149
2.6%
69.8%
76.1%
(6.3)
98,329
85,178
15.4%
Hawaii
$2
$2
(4.9)%
$3
$2
6.6%
109.7%
97.8%
11.8
992
1,271
(22.0)%
Idaho
$39
$37
5.3%
$29
$29
(1.5)%
74.8%
79.8%
(5.0)
15,211
14,579
4.3%
Illinois
$1,023
$1,014
0.9%
$734
$798
0.0%
70.6%
79.1%
(8.5)
393,439
374,810
5.0%
Indiana
$158
$153
3.3%
$106
$112
(5.6)%
67.1%
73.2%
(6.1)
62,048
59,140
4.9%
Iowa
$445
$427
4.1%
$371
$366
1.3%
83.4%
85.7%
(2.3)
190,996
180,908
5.6%
Kansas
$47
$33
40.7%
$34
$25
32.5%
72.5%
76.8%
(4.3)
26,646
14,069
89.4%
Kentucky
$196
$185
6.1%
$131
$140
(6.2)%
66.8%
75.5%
(8.7)
79,158
79,207
(0.1)%
Louisiana
$123
$117
5.4%
$94
$96
(2.4)%
76.1%
82.2%
(6.1)
52,908
47,397
11.6%
Maine
$65
$61
7.9%
$48
$51
(5.0)%
73.5%
84.4%
(10.8)
26,720
26,200
2.0%
Maryland
$183
$180
1.8%
$119
$132
(10.1)%
65.2%
73.8%
(8.6)
65,549
61,347
6.8%
Massachusetts
$754
$724
4.1%
$620
$668
(7.2)%
82.2%
92.2%
(10.0)
316,833
312,297
1.5%
Michigan
$484
$504
(4.1)%
$363
$420
(13.7)%
74.9%
83.3%
(8.4)
165,475
171,951
(3.8)%
Minnesota
$541
$537
0.8%
$386
$441
(12.5)%
71.4%
82.2%
(10.8)
188,172
195,350
(3.7)%
Mississippi
$42
$40
5.6%
$34
$36
(5.4)%
81.3%
90.7%
(9.4)
16,215
14,328
13.2%
Missouri
$156
$144
8.0%
$112
$111
0.6%
71.7%
76.8%
(5.2)
61,539
57,272
7.5%
Montana
$76
$66
15.7%
$48
$50
(4.3)%
68.0%
75.5%
(7.4)
29,376
27,415
7.2%
Nebraska
$174
$174
(0.0)%
$121
$136
(11.4)%
69.3%
78.2%
(8.9)
60,842
61,704
(1.4)%
Nevada
$34
$33
5.6%
$23
$24
(4.5)%
66.3%
73.7%
(7.5)
13,893
12,977
7.1%
New Hampshire
$113
$106
5.9%
$79
$86
(8.6)%
70.0%
80.6%
(10.6)
46,351
44,297
4.6%
New Jersey
$332
$321
3.5%
$245
$258
(5.0)%
73.6%
80.1%
(6.4)
124,392
115,493
7.7%
New Mexico
$22
$22
1.5%
$15
$16
(5.9)%
69.4%
76.4%
(7.0)
9,635
9,221
4.5%
New York
$1,320
$1,292
2.2%
$976
$1,049
(6.9)%
78.3%
80.1%
(1.8)
449,832
453,153
(0.7)%
North Carolina
$424
$405
4.7%
$302
$304
(0.6)%
71.2%
75.0%
(3.7)
183,464
168,285
9.0%
North Dakota
$108
$102
5.1%
$77
$84
(8.0)%
71.4%
81.5%
(10.2)
40,984
40,400
1.4%
Ohio
$538
$473
13.6%
$401
$380
5.3%
74.6%
80.6%
(5.9)
261,781
251,292
4.2%
Oklahoma
$150
$145
3.5%
$113
$115
(1.9)%
74.2%
80.1%
(5.9)
67,100
63,777
5.2%
Oregon
$96
$127
(23.8)%
$72
$103
(29.9)%
75.1%
81.7%
(6.6)
44,757
40,336
11.0%
Pennsylvania
$379
$377
0.6%
$290
$318
0.0%
76.7%
84.3%
(7.7)
201,593
186,683
8.0%
Rhode Island
$63
$62
1.7%
$45
$54
(16.7)%
72.1%
88.0%
(15.9)
25,945
26,670
(2.7)%
South Carolina
$181
$166
8.8%
$124
$118
4.9%
68.6%
71.1%
(2.5)
86,340
73,704
17.1%
South Dakota
$82
$81
0.9%
$67
$68
(1.0)%
82.1%
83.7%
(1.6)
36,193
35,401
2.2%
Tennessee
$297
$290
2.5%
$209
$216
(2.8)%
70.4%
74.3%
(3.9)
125,531
121,585
3.2%
Texas
$529
$458
15.5%
$389
$353
10.1%
73.5%
77.9%
(4.4)
244,652
202,755
20.7%
Utah
$58
$55
6.7%
$39
$39
(1.1)%
66.7%
71.9%
(5.1)
25,410
23,415
8.5%
Vermont
$33
$31
8.6%
$23
$24
(4.2)%
70.1%
79.5%
(9.4)
15,071
14,174
6.3%
Virginia
$357
$335
6.6%
$242
$252
(4.0)%
67.7%
75.2%
(7.5)
158,529
150,506
5.3%
Washington
$284
$243
16.8%
$188
$176
6.8%
66.3%
72.6%
(6.2)
121,507
102,278
18.8%
West Virginia
$27
$26
5.0%
$21
$22
(1.2)%
78.7%
83.7%
(5.0)
10,871
10,771
0.9%
Wisconsin
$310
$298
4.1%
$207
$216
(4.0)%
67.0%
72.6%
(5.6)
99,211
91,205
8.8%
Wyoming
$27
$26
3.9%
$20
$21
(5.6)%
72.2%
79.5%
(7.3)
11,728
11,671
0.5%
American Samoa
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Guam
-
-
0.0%
-
-
0.0%
235.0%
0.0%
235.0
-
-
0.0%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Puerto Rico
$15
$16
(4.7)%
$10
$14
(29.2)%
62.1%
83.7%
(21.5)
9,712
11,101
(12.5)%
U.S. Virgin Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Aggregate Other Alien
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Grand Totals
$12,041
$11,546
4.3%
$8,811
$9,274
(5.0)%
73.6%
80.3%
(6.7)
4,903,622
4,684,916
4.7%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Medicare Supplement
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
16 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$43
$42
0.9%
$26
$28
(6.6)%
61.4%
66.4%
(4.9)
537,304
523,378
2.7%
Alaska
$3
$3
(4.1)%
$2
$2
(15.8)%
57.5%
65.5%
(8.0)
32,293
34,033
(5.1)%
Arizona
$62
$64
(3.1)%
$42
$50
(14.9)%
67.5%
76.9%
(9.4)
1,076,890
1,113,523
(3.3)%
Arkansas
$21
$23
(9.5)%
$12
$15
(20.3)%
57.4%
65.3%
(7.8)
211,710
195,107
8.5%
California
$50
$45
10.2%
$24
$27
(10.1)%
49.1%
60.2%
(11.1)
679,167
638,118
6.4%
Colorado
$59
$64
(7.8)%
$39
$45
(12.6)%
67.4%
71.2%
(3.7)
855,847
875,649
(2.3)%
Connecticut
$36
$36
(1.6)%
$26
$28
(7.8)%
73.2%
78.0%
(4.9)
499,732
505,052
(1.1)%
Delaware
$11
$12
(4.4)%
$8
$9
(16.4)%
66.1%
75.6%
(9.5)
145,395
158,690
(8.4)%
District of Columbia
$16
$15
6.5%
$13
$13
0.6%
82.3%
87.2%
(4.8)
54,025
53,376
1.2%
Florida
$145
$133
8.9%
$86
$97
(10.8)%
59.6%
72.8%
(13.2)
2,128,862
2,097,742
1.5%
Georgia
$91
$88
3.3%
$59
$62
(5.9)%
64.7%
71.1%
(6.4)
1,235,466
1,186,522
4.1%
Hawaii
$12
$12
(3.4)%
$9
$11
(13.4)%
78.1%
87.2%
(9.1)
0
0
0.0%
Idaho
$17
$17
(4.4)%
$10
$11
(9.7)%
61.5%
65.1%
(3.6)
203,369
206,693
(1.6)%
Illinois
$163
$157
3.7%
$119
$126
0.0%
73.4%
80.1%
(6.7)
2,202,898
2,127,710
3.5%
Indiana
$63
$67
(6.2)%
$43
$49
(11.0)%
69.4%
73.2%
(3.8)
976,855
1,002,091
(2.5)%
Iowa
$13
$13
(1.0)%
$8
$9
(6.8)%
64.8%
68.8%
(4.0)
161,335
159,562
1.1%
Kansas
$16
$15
6.4%
$11
$11
(0.6)%
67.0%
71.7%
(4.7)
207,569
181,450
14.4%
Kentucky
$41
$40
2.7%
$25
$27
(5.4)%
62.5%
68.0%
(5.5)
589,823
568,118
3.8%
Louisiana
$24
$22
4.8%
$16
$16
(0.3)%
66.4%
69.7%
(3.4)
319,681
309,693
3.2%
Maine
$13
$14
(4.6)%
$9
$10
(12.7)%
66.0%
72.1%
(6.1)
239,175
241,171
(0.8)%
Maryland
$53
$52
1.6%
$38
$38
(0.9)%
71.2%
72.9%
(1.8)
560,491
553,842
1.2%
Massachusetts
$52
$51
1.9%
$31
$35
(10.5)%
60.3%
68.6%
(8.3)
733,731
709,143
3.5%
Michigan
$104
$109
(5.0)%
$73
$86
(15.2)%
76.0%
83.9%
(7.9)
2,232,055
2,273,868
(1.8)%
Minnesota
$50
$51
(1.0)%
$35
$39
(9.2)%
70.2%
76.5%
(6.3)
678,053
660,458
2.7%
Mississippi
$10
$10
6.0%
$6
$7
(3.0)%
61.2%
66.9%
(5.7)
143,416
133,871
7.1%
Missouri
$134
$127
5.4%
$76
$78
(2.9)%
57.1%
62.0%
(4.9)
1,339,671
1,280,072
4.7%
Montana
$4
$4
(3.7)%
$2
$2
(6.7)%
60.3%
62.3%
(2.0)
67,309
69,670
(3.4)%
Nebraska
$8
$9
(15.5)%
$6
$7
(19.0)%
70.9%
74.0%
(3.0)
96,533
121,170
(20.3)%
Nevada
$14
$14
(1.5)%
$9
$10
(8.4)%
64.9%
69.8%
(4.9)
192,269
188,378
2.1%
New Hampshire
$8
$10
(19.1)%
$4
$6
(29.2)%
54.7%
62.5%
(7.8)
110,310
138,750
(20.5)%
New Jersey
$89
$90
(1.0)%
$63
$70
(9.9)%
71.5%
78.6%
(7.1)
1,230,563
1,220,107
0.9%
New Mexico
$10
$13
(20.9)%
$6
$8
(28.5)%
58.1%
64.3%
(6.2)
134,774
162,336
(17.0)%
New York
$120
$118
1.8%
$79
$89
(10.9)%
65.9%
75.3%
(9.5)
1,753,176
1,698,916
3.2%
North Carolina
$92
$91
1.2%
$64
$70
(7.8)%
70.0%
76.8%
(6.8)
1,126,285
1,068,748
5.4%
North Dakota
$7
$7
(3.8)%
$4
$5
(7.7)%
62.1%
64.8%
(2.6)
71,640
74,816
(4.2)%
Ohio
$139
$143
(3.2)%
$96
$105
(8.7)%
69.3%
73.5%
(4.1)
1,946,049
1,952,235
(0.3)%
Oklahoma
$49
$51
(4.1)%
$35
$37
(5.5)%
70.9%
71.9%
(1.0)
630,725
631,841
(0.2)%
Oregon
$25
$26
(4.6)%
$14
$16
(11.8)%
58.1%
62.8%
(4.7)
326,363
332,994
(2.0)%
Pennsylvania
$139
$143
(2.7)%
$95
$112
0.0%
68.1%
78.5%
(10.4)
1,782,487
1,811,581
(1.6)%
Rhode Island
$19
$30
(35.4)%
$12
$24
(50.0)%
63.5%
82.0%
(18.5)
165,111
354,459
(53.4)%
South Carolina
$38
$39
(3.9)%
$29
$29
(0.2)%
77.3%
74.4%
2.8
590,027
535,164
10.3%
South Dakota
$14
$14
5.2%
$10
$11
(6.0)%
77.2%
86.6%
(9.3)
173,280
172,884
0.2%
Tennessee
$69
$69
(0.1)%
$50
$48
3.4%
72.1%
69.7%
2.5
1,037,653
1,047,003
(0.9)%
Texas
$210
$223
(5.9)%
$170
$192
(11.2)%
81.2%
86.1%
(4.9)
3,029,754
3,163,407
(4.2)%
Utah
$21
$20
2.8%
$13
$13
(2.9)%
61.1%
64.8%
(3.6)
346,044
344,393
0.5%
Vermont
$6
$5
8.5%
$3
$3
(6.9)%
57.8%
67.3%
(9.5)
74,847
70,144
6.7%
Virginia
$112
$108
3.5%
$79
$83
(4.4)%
71.0%
76.6%
(5.6)
1,353,852
1,270,269
6.6%
Washington
$54
$68
(20.8)%
$33
$48
(30.9)%
61.7%
70.7%
(9.0)
946,697
1,044,567
(9.4)%
West Virginia
$5
$6
(14.0)%
$4
$4
(16.6)%
68.4%
70.5%
(2.2)
47,478
47,106
0.8%
Wisconsin
$69
$70
(1.1)%
$44
$48
(8.7)%
64.2%
69.5%
(5.3)
1,029,059
1,010,509
1.8%
Wyoming
$1
$3
0.0%
$3
$3
(6.4)%
59.9%
78.3%
(18.3)
434
495
(12.3)%
American Samoa
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Guam
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Puerto Rico
$1
$4
(63.8)%
$3
$1
222.0%
24.8%
0.0%
24.8
3,403
517
558.2%
U.S. Virgin Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Aggregate Other Alien
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Grand Totals
$2,619
$2,654
(1.3)%
$1,774
$1,969
(9.9)%
68.0%
74.5%
(6.5)
36,310,935
36,321,391
(0.0)%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Vision Coverage
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
17 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$187
$189
(1.2)%
$125
$147
(15.2)%
67.8%
77.9%
(10.1)
653,081
652,214
0.1%
Alaska
$18
$16
10.8%
$12
$13
(2.1)%
70.2%
79.5%
(9.4)
35,479
36,263
(2.2)%
Arizona
$187
$185
1.1%
$120
$131
(8.5)%
64.5%
71.2%
(6.7)
663,825
666,041
(0.3)%
Arkansas
$181
$192
(5.6)%
$123
$145
(15.1)%
68.2%
75.5%
(7.3)
483,963
468,860
3.2%
California
$583
$579
0.8%
$339
$398
(15.0)%
58.3%
69.0%
(10.6)
1,167,398
1,144,503
2.0%
Colorado
$772
$789
(2.2)%
$646
$741
(12.8)%
85.8%
94.9%
(9.1)
2,585,764
2,611,233
(1.0)%
Connecticut
$81
$82
(1.8)%
$50
$58
(13.6)%
62.1%
70.6%
(8.5)
209,897
208,863
0.5%
Delaware
$53
$60
(12.1)%
$37
$49
(23.4)%
68.9%
80.7%
(11.8)
124,731
140,937
(11.5)%
District of Columbia
$398
$364
9.2%
$268
$306
(12.3)%
67.7%
84.0%
(16.3)
890,516
879,527
1.2%
Florida
$485
$480
1.1%
$323
$344
(6.2)%
69.8%
71.9%
(2.1)
1,967,085
1,983,574
(0.8)%
Georgia
$360
$344
4.6%
$238
$258
(7.8)%
69.9%
75.4%
(5.5)
1,049,346
1,010,387
3.9%
Hawaii
$61
$63
(4.1)%
$39
$45
(13.7)%
63.8%
70.9%
(7.1)
2,387
2,455
(2.8)%
Idaho
$121
$115
4.9%
$94
$95
(1.8)%
77.9%
83.0%
(5.1)
248,405
234,283
6.0%
Illinois
$471
$446
5.6%
$299
$322
0.0%
63.7%
72.4%
(8.7)
1,313,114
1,274,201
3.1%
Indiana
$208
$208
0.1%
$148
$162
(8.5)%
71.3%
101.0%
(29.7)
710,606
713,192
(0.4)%
Iowa
$34
$32
5.1%
$22
$25
(13.4)%
64.2%
77.9%
(13.7)
97,003
94,409
2.7%
Kansas
$112
$121
(7.4)%
$87
$93
(7.0)%
534.9%
608.5%
(73.7)
328,002
328,055
(0.0)%
Kentucky
$251
$220
14.1%
$172
$186
(7.2)%
68.7%
84.4%
(15.7)
959,532
920,312
4.3%
Louisiana
$120
$113
6.3%
$88
$97
(8.9)%
75.7%
86.2%
(10.5)
392,238
389,295
0.8%
Maine
$11
$80
(86.2)%
$7
$64
(89.8)%
62.5%
80.3%
(17.7)
28,939
192,817
(85.0)%
Maryland
$208
$214
(2.8)%
$128
$151
(15.2)%
63.9%
70.8%
(6.9)
451,935
499,322
(9.5)%
Massachusetts
$629
$686
(8.4)%
$410
$513
(20.1)%
104.0%
120.2%
(16.3)
1,420,248
1,441,273
(1.5)%
Michigan
$785
$848
(7.5)%
$614
$711
(13.6)%
78.2%
84.1%
(5.9)
3,202,577
3,083,075
3.9%
Minnesota
$254
$256
(0.8)%
$172
$202
(14.5)%
180.2%
78.4%
101.8
704,852
768,586
(8.3)%
Mississippi
$87
$88
(1.5)%
$43
$52
(17.4)%
54.5%
58.9%
(4.4)
197,339
198,582
(0.6)%
Missouri
$200
$202
(0.9)%
$174
$188
(7.4)%
87.7%
93.6%
(5.8)
1,873,629
1,877,071
(0.2)%
Montana
$22
$20
9.8%
$12
$12
(3.0)%
54.9%
59.9%
(5.0)
57,311
52,094
10.0%
Nebraska
$13
$12
7.8%
$9
$9
0.1%
66.2%
72.0%
(5.8)
42,964
41,316
4.0%
Nevada
$163
$167
(2.5)%
$122
$129
(5.8)%
71.5%
75.9%
(4.4)
906,694
803,548
12.8%
New Hampshire
$12
$79
(84.4)%
$7
$60
(87.7)%
60.4%
76.6%
(16.3)
30,519
152,678
(80.0)%
New Jersey
$459
$490
(6.3)%
$354
$421
(16.0)%
164.4%
179.5%
(15.2)
1,468,460
1,542,337
(4.8)%
New Mexico
$75
$78
(4.2)%
$53
$60
(12.6)%
70.6%
77.4%
(6.8)
219,144
211,357
3.7%
New York
$679
$684
(0.7)%
$433
$536
(19.1)%
69.6%
77.8%
(8.2)
2,094,104
2,145,140
(2.4)%
North Carolina
$199
$185
7.8%
$144
$144
0.2%
73.8%
79.6%
(5.7)
576,744
498,504
15.7%
North Dakota
$42
$37
12.2%
$32
$34
(7.3)%
158.7%
90.7%
68.0
111,183
115,465
(3.7)%
Ohio
$475
$503
(5.7)%
$431
$399
8.0%
91.1%
79.6%
11.5
1,766,271
1,835,827
(3.8)%
Oklahoma
$216
$207
4.5%
$154
$164
(6.3)%
312.7%
359.3%
(46.6)
506,045
515,163
(1.8)%
Oregon
$368
$360
2.1%
$303
$309
(1.9)%
82.4%
85.8%
(3.4)
395,313
401,977
(1.7)%
Pennsylvania
$518
$528
(1.7)%
$364
$436
0.0%
73.6%
82.9%
(9.2)
1,464,414
1,479,280
(1.0)%
Rhode Island
$111
$148
(25.3)%
$74
$115
(35.6)%
67.7%
77.3%
(9.7)
237,029
394,376
(39.9)%
South Carolina
$152
$143
6.2%
$114
$109
4.4%
75.0%
76.3%
(1.3)
757,222
718,942
5.3%
South Dakota
$68
$66
2.9%
$67
$55
21.5%
97.6%
72.4%
25.2
82,587
81,826
0.9%
Tennessee
$359
$355
0.9%
$251
$286
(12.2)%
71.9%
83.0%
(11.1)
930,450
909,362
2.3%
Texas
$1,229
$1,282
(4.1)%
$936
$1,060
(11.7)%
159.2%
186.3%
(27.1)
4,275,662
3,964,467
7.8%
Utah
$122
$100
21.8%
$83
$84
(0.7)%
68.9%
84.0%
(15.1)
424,229
354,856
19.5%
Vermont
$1
$34
(97.4)%
$
$27
(98.1)%
58.1%
79.1%
(21.1)
1,427
71,291
(98.0)%
Virginia
$438
$454
(3.5)%
$290
$341
(14.9)%
162.4%
196.0%
(33.7)
1,213,690
1,236,573
(1.9)%
Washington
$576
$691
(16.7)%
$439
$578
(24.0)%
77.0%
83.9%
(6.9)
1,297,440
1,441,792
(10.0)%
West Virginia
$38
$37
4.6%
$23
$25
(7.3)%
60.2%
68.4%
(8.1)
128,177
124,741
2.8%
Wisconsin
$333
$341
(2.3)%
$246
$277
(11.1)%
73.2%
81.0%
(7.9)
901,143
903,727
(0.3)%
Wyoming
$23
$23
(3.0)%
$17
$18
(3.1)%
77.2%
77.3%
(0.1)
127,031
120,145
5.7%
American Samoa
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Guam
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Puerto Rico
$29
$26
9.9%
$17
$19
(12.1)%
57.7%
863.3%
(805.7)
365,989
468,318
(21.9)%
U.S. Virgin Islands
$2
$2
(18.3)%
-
-
0.0%
24.8%
40.9%
(16.1)
288
315
(8.6)%
Aggregate Other Alien
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Grand Totals
$13,579
$14,048
(3.3)%
$9,753
$11,201
(12.9)%
84.3%
92.1%
(7.8)
42,143,385
42,404,747
(0.6)%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Dental Insurance
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
18 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$893
$846
5.5%
$811
$832
(2.5)%
93.4%
96.3%
(2.9)
152,711
150,486
1.5%
Alaska
$468
$450
4.0%
$432
$426
1.4%
92.3%
94.6%
(2.4)
48,410
46,958
3.1%
Arizona
$732
$683
7.2%
$643
$633
1.6%
89.0%
92.9%
(3.9)
128,675
125,538
2.5%
Arkansas
$309
$291
6.2%
$257
$263
(2.1)%
86.7%
89.9%
(3.2)
76,509
73,517
4.1%
California
$6
$6
(3.9)%
$5
$6
(16.9)%
81.2%
93.9%
(12.7)
17,061
16,484
3.5%
Colorado
$905
$891
1.6%
$775
$802
(3.4)%
88.8%
92.4%
(3.7)
121,515
120,936
0.5%
Connecticut
$309
$324
(4.7)%
$287
$296
(3.1)%
92.2%
95.0%
(2.9)
40,485
40,109
0.9%
Delaware
$165
$154
7.2%
$153
$148
3.7%
92.7%
95.3%
(2.6)
22,281
21,452
3.9%
District of Columbia
$1,874
$1,836
2.1%
$1,484
$1,656
(10.4)%
80.1%
89.9%
(9.8)
2,661,692
2,519,664
5.6%
Florida
$2,781
$2,589
7.4%
$2,470
$2,434
1.5%
91.6%
94.3%
(2.8)
436,719
424,315
2.9%
Georgia
$1,596
$1,627
(2.0)%
$1,475
$1,556
(5.2)%
103.6%
95.6%
8.0
228,947
226,484
1.1%
Hawaii
$464
$455
2.1%
$414
$406
2.0%
89.2%
89.3%
(0.1)
79,124
78,643
0.6%
Idaho
$215
$212
1.5%
$193
$193
0.2%
89.8%
91.5%
(1.7)
43,780
43,315
1.1%
Illinois
$1,232
$1,231
0.1%
$1,133
$1,204
0.0%
91.6%
95.0%
(3.4)
185,680
186,232
(0.3)%
Indiana
$720
$744
(3.3)%
$654
$673
(2.8)%
92.2%
94.9%
(2.7)
98,721
97,963
0.8%
Iowa
$279
$258
7.9%
$257
$236
8.7%
89.1%
90.6%
(1.5)
48,067
47,251
1.7%
Kansas
$144
$136
5.2%
$129
$130
(0.8)%
89.3%
95.5%
(6.2)
20,359
20,738
(1.8)%
Kentucky
$492
$484
1.7%
$446
$450
(1.0)%
91.0%
93.6%
(2.6)
82,975
82,318
0.8%
Louisiana
$474
$437
8.4%
$430
$412
4.2%
90.1%
93.2%
(3.0)
73,608
73,514
0.1%
Maine
$221
$227
(2.4)%
$202
$209
(3.3)%
90.4%
93.7%
(3.3)
37,829
37,199
1.7%
Maryland
$3,864
$3,615
6.9%
$3,341
$3,384
(1.3)%
90.0%
92.8%
(2.8)
584,325
577,728
1.1%
Massachusetts
$845
$823
2.6%
$757
$774
(2.2)%
93.6%
96.4%
(2.7)
113,110
112,673
0.4%
Michigan
$799
$793
0.8%
$720
$739
(2.5)%
90.1%
93.2%
(3.0)
128,814
128,263
0.4%
Minnesota
$664
$682
(2.7)%
$608
$652
(6.7)%
92.4%
95.5%
(3.0)
90,887
89,174
1.9%
Mississippi
$381
$357
6.6%
$349
$337
3.5%
91.7%
94.5%
(2.8)
68,208
67,590
0.9%
Missouri
$806
$779
3.4%
$740
$733
0.9%
91.9%
95.5%
(3.6)
107,309
106,690
0.6%
Montana
$220
$201
9.2%
$206
$197
4.9%
92.3%
95.6%
(3.3)
33,158
32,493
2.0%
Nebraska
$275
$267
3.1%
$245
$246
(0.5)%
88.9%
92.1%
(3.2)
35,836
35,471
1.0%
Nevada
$250
$257
(2.7)%
$221
$225
(1.8)%
90.5%
92.4%
(1.9)
41,389
40,321
2.6%
New Hampshire
$298
$304
(2.2)%
$269
$291
(7.6)%
92.5%
95.5%
(3.0)
35,625
35,002
1.8%
New Jersey
$920
$902
2.1%
$841
$845
(0.5)%
91.4%
93.7%
(2.2)
126,703
126,111
0.5%
New Mexico
$366
$363
1.0%
$324
$361
(10.3)%
88.2%
93.4%
(5.2)
57,874
58,493
(1.1)%
New York
$1,716
$1,734
(1.0)%
$1,618
$1,650
(1.9)%
92.7%
94.2%
(1.5)
230,763
241,270
(4.4)%
North Carolina
$1,468
$1,261
16.5%
$1,151
$1,199
(4.1)%
89.3%
93.6%
(4.3)
175,738
172,662
1.8%
North Dakota
$132
$130
1.3%
$120
$121
(0.8)%
91.4%
93.5%
(2.0)
19,759
19,415
1.8%
Ohio
$1,245
$1,265
(1.6)%
$1,137
$1,183
(3.9)%
91.8%
94.4%
(2.6)
172,805
170,857
1.1%
Oklahoma
$771
$759
1.6%
$709
$719
(1.3)%
91.0%
94.4%
(3.4)
127,748
126,540
1.0%
Oregon
$533
$503
5.9%
$468
$492
(4.9)%
89.6%
92.7%
(3.0)
73,234
72,874
0.5%
Pennsylvania
$1,757
$1,744
0.7%
$1,586
$1,614
0.0%
91.3%
94.2%
(2.9)
392,806
394,016
(0.3)%
Rhode Island
$116
$118
(1.4)%
$102
$108
(5.1)%
88.3%
91.8%
(3.5)
22,641
22,114
2.4%
South Carolina
$626
$582
7.5%
$557
$557
(0.1)%
91.3%
93.7%
(2.4)
88,053
86,667
1.6%
South Dakota
$188
$169
10.8%
$173
$156
10.6%
90.0%
92.1%
(2.1)
29,047
28,298
2.6%
Tennessee
$798
$762
4.7%
$711
$707
0.6%
89.1%
92.6%
(3.6)
111,150
110,738
0.4%
Texas
$3,372
$3,003
12.3%
$3,048
$3,013
1.2%
92.4%
95.4%
(3.0)
482,241
474,600
1.6%
Utah
$605
$585
3.5%
$562
$577
(2.5)%
92.4%
92.9%
(0.5)
100,137
98,797
1.4%
Vermont
$89
$93
(3.7)%
$75
$88
(15.7)%
90.1%
94.7%
(4.6)
14,729
14,573
1.1%
Virginia
$2,778
$2,818
(1.4)%
$2,502
$2,666
(6.2)%
91.4%
94.3%
(2.9)
488,109
481,107
1.5%
Washington
$1,056
$1,092
(3.4)%
$954
$1,049
(9.0)%
90.6%
94.6%
(3.9)
232,891
232,914
(0.0)%
West Virginia
$437
$403
8.3%
$401
$388
3.3%
93.0%
95.3%
(2.3)
62,418
61,307
1.8%
Wisconsin
$648
$639
1.4%
$597
$617
(3.3)%
93.9%
96.4%
(2.5)
70,505
69,271
1.8%
Wyoming
$118
$111
5.8%
$100
$105
(5.0)%
88.9%
91.4%
(2.5)
17,569
17,117
2.6%
American Samoa
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Guam
$25
$23
0.0%
$27
$24
0.0%
112.3%
106.4%
5.9
6,151
6,325
(2.8)%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Puerto Rico
$191
$192
(0.5)%
$169
$178
(5.1)%
88.5%
92.9%
(4.3)
57,403
57,072
0.6%
U.S. Virgin Islands
$1
$3
(52.3)%
$2
$2
(31.2)%
108.9%
75.5%
33.4
496
531
(6.6)%
Aggregate Other Alien
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Grand Totals
$42,639
$41,218
3.4%
$38,038
$38,962
(2.4)%
91.1%
93.9%
(2.8)
9,004,779
8,802,190
2.3%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Federal Employees Health Benefit Plan
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
19 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$5,967
$4,959
20.3%
$5,012
$4,204
19.2%
84.1%
84.5%
(0.5)
471,755
408,793
15.4%
Alaska
-
-
0.0%
-
-
0.0%
-
-
-
-
-
0.0%
Arizona
$5,377
$4,931
9.0%
$4,482
$4,195
6.8%
83.4%
85.2%
(1.8)
441,509
429,510
2.8%
Arkansas
$2,382
$1,980
20.3%
$1,835
$1,575
16.5%
80.0%
85.7%
(5.7)
188,670
164,011
15.0%
California
$3,823
$3,699
3.4%
$3,254
$3,391
(4.0)%
85.7%
91.8%
(6.1)
288,995
280,574
3.0%
Colorado
$4,451
$3,893
14.3%
$3,695
$3,317
11.4%
83.0%
85.2%
(2.2)
391,415
366,786
6.7%
Connecticut
$3,490
$3,019
15.6%
$2,918
$2,750
6.1%
84.3%
90.7%
(6.4)
277,695
254,812
9.0%
Delaware
$267
$202
32.3%
$220
$179
23.1%
82.6%
87.9%
(5.3)
20,264
17,229
17.6%
District of Columbia
$213
$141
50.8%
$182
$115
58.7%
85.5%
81.1%
4.5
15,214
11,858
28.3%
Florida
$24,575
$23,341
5.3%
$20,466
$20,110
1.8%
83.3%
86.1%
(2.8)
1,655,988
1,672,291
(1.0)%
Georgia
$6,138
$5,008
22.6%
$4,958
$4,228
17.3%
86.6%
84.2%
2.4
503,655
445,427
13.1%
Hawaii
$1,276
$1,209
5.5%
$1,131
$1,104
2.5%
88.7%
91.3%
(2.6)
100,921
95,625
5.5%
Idaho
$1,142
$914
24.9%
$925
$788
17.3%
80.9%
86.3%
(5.4)
103,533
90,840
14.0%
Illinois
$9,281
$8,092
14.7%
$7,462
$6,674
0.0%
80.6%
82.7%
(2.1)
676,815
619,165
9.3%
Indiana
$3,854
$3,107
24.1%
$3,128
$2,584
21.1%
81.2%
83.2%
(2.0)
301,126
262,359
14.8%
Iowa
$1,555
$1,302
19.4%
$1,254
$1,095
14.6%
80.5%
84.1%
(3.5)
143,077
125,496
14.0%
Kansas
$1,316
$1,064
23.7%
$1,022
$879
16.2%
78.0%
82.6%
(4.6)
111,936
96,950
15.5%
Kentucky
$4,493
$3,713
21.0%
$3,621
$3,109
16.4%
81.6%
83.9%
(2.3)
362,057
312,610
15.8%
Louisiana
$4,631
$3,972
16.6%
$3,773
$3,326
13.4%
81.6%
83.8%
(2.2)
349,817
323,575
8.1%
Maine
$1,266
$925
36.8%
$1,002
$820
22.3%
79.5%
88.3%
(8.9)
126,419
98,019
29.0%
Maryland
$1,777
$1,521
16.8%
$1,587
$1,376
15.3%
95.8%
97.2%
(1.4)
121,140
111,559
8.6%
Massachusetts
$2,912
$2,575
13.1%
$2,425
$2,288
6.0%
83.2%
88.9%
(5.6)
234,363
212,526
10.3%
Michigan
$10,716
$9,304
15.2%
$8,846
$8,113
9.0%
82.6%
87.2%
(4.7)
5,984,261
758,478
689.0%
Minnesota
$4,585
$4,219
8.7%
$3,901
$3,603
8.3%
85.3%
85.4%
(0.2)
493,623
467,424
5.6%
Mississippi
$1,592
$1,285
23.8%
$1,267
$1,015
24.9%
79.9%
79.4%
0.5
135,081
115,000
17.5%
Missouri
$5,886
$5,200
13.2%
$4,749
$4,264
11.4%
80.8%
82.7%
(1.8)
467,056
426,770
9.4%
Montana
$480
$399
20.1%
$381
$343
11.1%
79.8%
85.9%
(6.1)
47,925
44,132
8.6%
Nebraska
$764
$546
40.0%
$616
$478
28.7%
80.9%
84.6%
(3.7)
63,234
47,776
32.4%
Nevada
$2,881
$2,518
14.4%
$2,507
$2,221
12.9%
87.0%
88.3%
(1.3)
206,729
188,721
9.5%
New Hampshire
$636
$511
24.3%
$509
$448
13.7%
80.2%
87.5%
(7.2)
60,907
49,540
22.9%
New Jersey
$7,010
$7,297
(3.9)%
$5,588
$6,189
(9.7)%
81.7%
84.7%
(3.1)
533,013
569,350
(6.4)%
New Mexico
$1,314
$1,128
16.5%
$1,088
$949
14.7%
83.4%
83.9%
(0.5)
134,041
116,820
14.7%
New York
$17,709
$15,948
11.0%
$15,487
$14,483
6.9%
108.8%
91.0%
17.8
1,395,870
1,289,034
8.3%
North Carolina
$9,259
$7,612
21.6%
$7,224
$6,378
13.3%
79.2%
84.0%
(4.8)
732,326
648,253
13.0%
North Dakota
$171
$145
17.9%
$125
$114
10.2%
73.1%
78.1%
(5.0)
24,996
23,252
7.5%
Ohio
$11,327
$9,873
14.7%
$9,288
$8,394
10.6%
82.2%
85.2%
(3.1)
863,937
786,827
9.8%
Oklahoma
$2,160
$1,799
20.1%
$1,710
$1,480
15.5%
80.1%
83.1%
(3.0)
171,702
151,312
13.5%
Oregon
$4,539
$4,083
11.2%
$3,725
$3,624
2.8%
82.6%
93.0%
(10.4)
376,157
360,909
4.2%
Pennsylvania
$14,550
$13,713
6.1%
$11,913
$11,405
0.0%
82.2%
83.3%
(1.0)
1,092,647
1,045,297
4.5%
Rhode Island
$1,048
$922
13.7%
$842
$771
9.2%
82.4%
83.2%
(0.8)
87,393
78,647
11.1%
South Carolina
$2,341
$1,791
30.7%
$1,867
$1,477
26.4%
79.9%
82.3%
(2.5)
196,931
157,716
24.9%
South Dakota
$293
$245
19.7%
$226
$205
10.3%
77.1%
83.7%
(6.5)
39,177
35,223
11.2%
Tennessee
$7,588
$6,661
13.9%
$5,948
$5,497
8.2%
78.8%
82.1%
(3.3)
558,132
521,620
7.0%
Texas
$25,619
$22,211
15.3%
$21,609
$19,387
11.5%
84.4%
87.5%
(3.1)
1,755,278
1,619,096
8.4%
Utah
$1,822
$1,562
16.6%
$1,537
$1,323
16.2%
84.6%
85.0%
(0.3)
161,115
143,358
12.4%
Vermont
$114
$71
61.6%
$93
$63
46.2%
78.7%
89.5%
(10.8)
13,061
8,743
49.4%
Virginia
$4,405
$3,507
25.6%
$3,608
$2,908
24.1%
82.6%
83.2%
(0.6)
357,162
300,111
19.0%
Washington
$5,123
$4,269
20.0%
$4,415
$3,849
14.7%
87.5%
90.3%
(2.8)
452,113
387,294
16.7%
West Virginia
$1,883
$1,586
18.7%
$1,551
$1,359
14.1%
82.7%
85.7%
(3.1)
146,511
128,960
13.6%
Wisconsin
$5,951
$5,240
13.6%
$4,733
$4,374
8.2%
82.7%
83.6%
(0.9)
531,150
494,879
7.3%
Wyoming
$5
$5
7.7%
$5
$5
3.4%
91.7%
95.5%
(3.8)
454
410
10.7%
American Samoa
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Guam
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Puerto Rico
$6,919
$6,294
9.9%
$5,563
$5,228
6.4%
114.3%
83.1%
31.2
608,203
596,440
2.0%
U.S. Virgin Islands
-
-
0.0%
-
-
0.0%
1,715.0%
(361.8)%
2,076.9
-
-
0.0%
Aggregate Other Alien
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Grand Totals
$248,793
$219,554
13.3%
$205,265
$188,050
9.2%
85.0%
85.9%
(0.9)
24,574,984
17,961,407
36.8%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Medicare
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
20 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$26
$22
23.2%
$26
$22
21.8%
99.1%
100.2%
(1.1)
-
-
0.0%
Alaska
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Arizona
$202
$79
156.2%
$182
$84
117.3%
89.8%
105.9%
(16.1)
44,116
20,054
120.0%
Arkansas
$1,280
$1,297
(1.3)%
$981
$984
(0.4)%
77.3%
87.1%
(9.8)
684,329
626,948
9.2%
California
-
$1,431
(100.0)%
$
$1,360
(100.0)%
0.0%
95.1%
(95.1)
0
401,314
(100.0)%
Colorado
$969
$922
5.1%
$927
$754
23.0%
97.5%
79.7%
17.9
1,186,124
933,029
27.1%
Connecticut
-
-
0.0%
$1
($1)
(196.1)%
-
-
0.0
-
-
0.0%
Delaware
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
District of Columbia
$1,144
$839
36.4%
$922
$709
29.9%
80.5%
84.5%
(4.0)
225,883
192,604
17.3%
Florida
$13,981
$14,575
(4.1)%
$11,722
$12,932
(9.4)%
83.9%
89.1%
(5.2)
2,950,439
2,898,557
1.8%
Georgia
$4,480
$4,338
3.3%
$3,619
$3,597
0.6%
80.8%
82.9%
(2.1)
1,682,879
1,402,346
20.0%
Hawaii
$1,867
$1,569
19.0%
$1,601
$1,509
6.1%
85.8%
95.7%
(10.0)
343,099
286,236
19.9%
Idaho
$409
$247
66.0%
$360
$232
54.8%
83.0%
106.7%
(23.7)
389,397
276,379
40.9%
Illinois
$12,757
$9,734
31.1%
$10,866
$8,868
0.0%
86.1%
90.9%
(4.8)
2,200,879
1,832,211
20.1%
Indiana
$6,894
$6,061
13.7%
$5,909
$5,360
10.2%
88.8%
88.8%
0.1
1,384,047
1,073,013
29.0%
Iowa
$5,510
$4,937
11.6%
$4,840
$4,452
8.7%
87.8%
91.5%
(3.7)
815,440
725,232
12.4%
Kansas
$3,723
$3,428
8.6%
$3,090
$3,009
2.7%
83.3%
88.5%
(5.2)
383,892
336,487
14.1%
Kentucky
$8,499
$7,341
15.8%
$6,953
$6,628
4.9%
82.2%
90.4%
(8.2)
1,342,465
1,220,171
10.0%
Louisiana
$9,308
$8,054
15.6%
$7,765
$7,037
10.3%
84.1%
89.8%
(5.7)
3,360,250
2,894,108
16.1%
Maine
-
-
0.0%
-
-
0.0%
-
-
0.0
0
0
0.0%
Maryland
$3,024
$2,623
15.3%
$2,452
$2,250
9.0%
82.7%
84.3%
(1.5)
658,999
572,590
15.1%
Massachusetts
$4,818
$4,475
7.7%
$4,512
$4,256
6.0%
93.9%
95.1%
(1.2)
758,348
660,278
14.9%
Michigan
$6,626
$6,282
5.5%
$5,308
$5,164
2.8%
82.0%
82.2%
(0.2)
2,041,971
1,752,641
16.5%
Minnesota
$7,398
$6,609
11.9%
$6,562
$6,108
7.4%
88.8%
92.6%
(3.8)
1,007,403
837,543
20.3%
Mississippi
$2,467
$2,377
3.8%
$1,938
$2,159
(10.2)%
80.6%
90.8%
(10.2)
475,561
437,155
8.8%
Missouri
$2,279
$1,963
16.1%
$1,873
$1,846
1.4%
82.2%
94.1%
(11.9)
729,417
558,564
30.6%
Montana
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Nebraska
$1,485
$1,310
13.3%
$1,225
$1,126
8.8%
84.1%
142.7%
(58.7)
579,717
489,674
18.4%
Nevada
$1,917
$1,798
6.6%
$1,590
$1,515
5.0%
85.0%
82.9%
2.0
572,874
461,166
24.2%
New Hampshire
$1,027
$912
12.6%
$885
$822
7.6%
86.2%
90.1%
(4.0)
206,877
171,520
20.6%
New Jersey
$10,962
$10,076
8.8%
$9,062
$9,106
(0.5)%
83.8%
90.4%
(6.6)
2,011,106
1,714,818
17.3%
New Mexico
$5,309
$4,366
21.6%
$4,342
$3,852
12.7%
81.8%
87.7%
(5.9)
747,846
669,693
11.7%
New York
$8,730
$8,030
8.7%
$7,823
$8,102
(3.4)%
91.6%
100.7%
(9.1)
1,282,715
1,124,537
14.1%
North Carolina
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
North Dakota
$299
$292
2.2%
$286
$293
(2.6)%
95.6%
100.3%
(4.7)
25,046
20,328
23.2%
Ohio
$20,126
$17,164
17.3%
$16,794
$14,843
13.1%
84.4%
86.5%
(2.0)
2,686,316
2,327,567
15.4%
Oklahoma
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Oregon
$5,425
$767
607.7%
$4,932
$698
606.2%
96.1%
91.1%
4.9
1,341,564
352,450
280.6%
Pennsylvania
$25,892
$20,706
25.0%
$23,687
$19,274
0.0%
91.6%
93.2%
(1.6)
4,310,051
3,632,600
18.6%
Rhode Island
$1,879
$1,785
5.3%
$1,668
$1,635
2.0%
88.8%
91.2%
(2.5)
285,254
251,732
13.3%
South Carolina
$3,290
$3,034
8.4%
$2,745
$2,721
0.9%
84.0%
89.6%
(5.7)
912,540
802,802
13.7%
South Dakota
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Tennessee
$6,286
$6,206
1.3%
$5,104
$5,155
(1.0)%
81.6%
83.4%
(1.8)
1,476,484
1,343,692
9.9%
Texas
$25,254
$22,041
14.6%
$20,578
$19,872
3.6%
84.7%
95.3%
(10.7)
5,671,409
4,829,321
17.4%
Utah
$840
$595
41.3%
$721
$512
40.9%
85.8%
88.7%
(2.8)
318,999
225,260
41.6%
Vermont
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Virginia
$11,246
$9,313
20.8%
$9,307
$8,322
11.8%
86.3%
89.9%
(3.5)
1,531,389
1,275,887
20.0%
Washington
$5,864
$5,031
16.6%
$4,838
$4,358
11.0%
82.8%
86.6%
(3.8)
1,753,093
1,572,333
11.5%
West Virginia
$1,794
$1,530
17.2%
$1,505
$1,401
7.5%
83.9%
91.3%
(7.4)
457,790
386,427
18.5%
Wisconsin
$2,343
$2,012
16.5%
$1,877
$1,782
5.4%
80.1%
88.6%
(8.4)
946,485
757,139
25.0%
Wyoming
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
American Samoa
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Guam
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Puerto Rico
$3,000
$1,993
50.5%
$2,723
$2,397
13.6%
121.4%
117.6%
3.8
1,182,514
1,120,425
5.5%
U.S. Virgin Islands
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Aggregate Other Alien
-
-
0.0%
-
-
0.0%
-
-
0.0
-
-
0.0%
Grand Totals
$234,421
$208,695
12.3%
$198,572
$187,106
6.1%
86.0%
90.8%
(4.8)
45,569,540
43,466,831
4.8%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Medicaid
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
21 | P a g e
© 2021 National Association of Insurance Commissioners
($ in Millions except Enrollment)
State 2020 2019 % Chg. 2020 2019 % Chg. 2020 2019
%
Pt Chg.
2020 2019
Alabama
$189
$214
(11.6)%
$143
$163
(12.1)%
78.2%
78.5%
(0.3)
245,122
268,655
(8.8)%
Alaska
$38
$16
144.1%
$35
$11
208.3%
91.1%
70.9%
20.2
49,900
23,019
116.8%
Arizona
$317
$300
5.9%
$292
$233
25.2%
91.7%
77.8%
13.9
1,544,718
1,456,258
6.1%
Arkansas
$165
$178
(7.2)%
$127
$131
(2.9)%
76.9%
76.7%
0.2
244,929
249,916
(2.0)%
California
$1,368
$1,376
(0.6)%
$1,054
$1,096
(3.8)%
76.3%
79.5%
(3.2)
3,399,266
3,602,198
(5.6)%
Colorado
$392
$329
19.2%
$434
$366
18.7%
110.4%
110.2%
0.2
632,204
553,653
14.2%
Connecticut
$245
$235
4.4%
$202
$190
6.0%
82.0%
81.2%
0.8
357,542
383,434
(6.8)%
Delaware
$40
$42
(4.3)%
$35
$36
(3.5)%
87.4%
85.7%
1.8
57,481
55,181
4.2%
District of Columbia
$30
$26
12.4%
$23
$25
(8.0)%
77.5%
100.7%
(23.2)
34,897
35,438
(1.5)%
Florida
$954
$1,190
(19.8)%
$941
$1,130
(16.8)%
98.0%
94.9%
3.1
1,386,601
1,350,471
2.7%
Georgia
$624
$563
10.8%
$766
$616
24.3%
121.5%
109.4%
12.1
1,114,551
1,041,406
7.0%
Hawaii
$103
$109
(5.9)%
$78
$85
(7.6)%
75.7%
76.9%
(1.2)
33,901
34,983
(3.1)%
Idaho
$117
$120
(2.7)%
$83
$98
(16.1)%
70.4%
81.7%
(11.3)
171,457
167,590
2.3%
Illinois
$1,225
$1,089
12.5%
$1,020
$934
9.2%
82.9%
85.4%
(2.4)
2,173,679
2,055,715
5.7%
Indiana
$613
$569
7.8%
$544
$467
16.3%
88.0%
82.9%
5.1
1,615,700
1,630,144
(0.9)%
Iowa
$420
$402
4.4%
$359
$335
7.3%
85.4%
83.3%
2.2
780,836
785,819
(0.6)%
Kansas
$193
$183
5.5%
$151
$156
(3.1)%
77.7%
85.2%
(7.4)
263,903
258,938
1.9%
Kentucky
$615
$687
(10.5)%
$583
$593
(1.6)%
94.3%
86.8%
7.5
709,251
697,078
1.7%
Louisiana
$237
$238
(0.4)%
$188
$182
3.8%
79.1%
78.3%
0.8
399,846
412,828
(3.1)%
Maine
$65
$60
8.5%
$52
$45
15.4%
78.1%
74.3%
3.8
108,845
104,961
3.7%
Maryland
$253
$240
5.3%
$209
$190
10.1%
82.3%
78.1%
4.2
460,321
452,425
1.7%
Massachusetts
$759
$734
3.4%
$618
$598
3.4%
81.3%
81.3%
(0.0)
535,612
532,232
0.6%
Michigan
$769
$784
(1.8)%
$524
$529
(0.8)%
68.0%
66.8%
1.2
524,316
529,444
(1.0)%
Minnesota
$757
$748
1.2%
$1,575
$731
115.5%
208.8%
95.7%
113.1
445,731
470,031
(5.2)%
Mississippi
$169
$190
(11.1)%
$132
$131
1.2%
77.4%
69.7%
7.7
556,068
574,758
(3.3)%
Missouri
$490
$398
23.2%
$492
$356
38.2%
98.7%
89.1%
9.6
756,568
681,658
11.0%
Montana
$68
$68
(0.2)%
$51
$52
(0.6)%
75.6%
75.3%
0.4
146,366
120,411
21.6%
Nebraska
$253
$155
63.8%
$161
$108
49.6%
63.1%
71.0%
(7.9)
196,474
187,781
4.6%
Nevada
$61
$72
(15.0)%
$53
$57
(6.4)%
85.0%
77.7%
7.2
118,862
110,445
7.6%
New Hampshire
$71
$72
(2.1)%
$56
$54
3.8%
77.7%
74.5%
3.2
117,889
112,752
4.6%
New Jersey
$592
$543
9.0%
$602
$480
25.5%
149.6%
121.7%
27.9
3,714,757
3,534,000
5.1%
New Mexico
$108
$102
5.8%
$91
$89
2.2%
83.9%
87.4%
(3.5)
179,718
151,229
18.8%
New York
$1,831
$1,786
2.5%
$1,383
$1,429
(3.2)%
79.2%
82.2%
(2.9)
3,129,463
3,239,761
(3.4)%
North Carolina
$567
$572
(0.9)%
$474
$472
0.3%
83.3%
82.2%
1.1
583,865
598,150
(2.4)%
North Dakota
$172
$176
(1.9)%
$129
$135
(4.9)%
74.5%
77.1%
(2.6)
201,950
83,920
140.6%
Ohio
$1,047
$957
9.4%
$1,139
$950
19.9%
107.9%
99.9%
8.0
2,059,273
1,965,365
4.8%
Oklahoma
$243
$249
(2.3)%
$186
$184
1.4%
77.0%
74.9%
2.1
402,019
416,332
(3.4)%
Oregon
$164
$128
28.3%
$397
$310
28.1%
241.8%
241.2%
0.6
237,104
233,580
1.5%
Pennsylvania
$956
$939
1.8%
$795
$778
2.2%
82.9%
83.0%
(0.1)
1,048,432
1,036,557
1.1%
Rhode Island
$62
$55
12.5%
$45
$41
10.5%
73.8%
74.8%
(1.0)
99,586
98,132
1.5%
South Carolina
$237
$220
7.8%
$195
$173
12.7%
82.4%
78.8%
3.6
437,513
389,454
12.3%
South Dakota
$107
$102
4.7%
$96
$82
18.2%
90.0%
79.9%
10.2
167,859
160,363
4.7%
Tennessee
$321
$335
(4.3)%
$271
$267
1.5%
84.0%
79.5%
4.5
605,682
657,092
(7.8)%
Texas
$1,469
$1,168
25.8%
$1,341
$937
43.1%
90.8%
80.3%
10.5
2,455,352
2,178,632
12.7%
Utah
$138
$127
8.1%
$105
$104
0.9%
75.8%
81.1%
(5.3)
175,001
169,879
3.0%
Vermont
$65
$49
32.8%
$42
$30
40.0%
64.9%
61.6%
3.3
174,015
175,039
(0.6)%
Virginia
$502
$493
1.8%
$553
$443
24.8%
110.7%
91.2%
19.5
1,078,591
1,051,915
2.5%
Washington
$340
$201
69.2%
$309
$195
59.0%
91.5%
96.4%
(4.9)
560,035
308,632
81.5%
West Virginia
$106
$123
(13.8)%
$84
$92
(9.4)%
78.9%
75.6%
3.3
121,709
131,155
(7.2)%
Wisconsin
$412
$363
13.3%
$346
$293
18.1%
83.0%
80.4%
2.6
546,236
534,244
2.2%
Wyoming
$34
$31
9.4%
$23
$21
9.1%
67.7%
68.1%
(0.5)
55,444
51,758
7.1%
American Samoa
-
-
0.0%
-
-
0.0%
0.0%
0.0%
-
-
-
0.0%
Guam
$1
$1
0.0%
-
-
0.0%
77.4%
22.7%
54.6
58
57
1.8%
Northern Mariana Islands
-
-
0.0%
-
-
0.0%
91.3%
0.1%
91.3
3
3
0.0%
Puerto Rico
$1
$1
(10.8)%
$2
$2
(1.0)%
37.7%
34.0%
3.7
743
756
(1.7)%
U.S. Virgin Islands
$2
$1
299.4%
$1
$1
(42.1)%
40.4%
49.3%
(9.0)
1,280
61
1,998.4%
Aggregate Other Alien
$2
$4
(50.4)%
-
-
0.0%
3.6%
0.9%
2.7
545
625
(12.8)%
Grand Totals
$21,144
$20,170
4.8%
$19,591
$17,202
13.9%
93.8%
86.4%
7.4
37,219,069
36,106,313
3.1%
*Based on earned premium. This loss ratio should not to be confused with the Preliminary MLR on the Supplemental Health Care Exhbit.
% Chg.
Direct Written Premium Claims Loss Ratio*
Table 4 - Other Health
As reported in the
Exhibit of Premiums, Enrollment and Utilization
Enrollment
U.S. Health Insurance Industry | 2020 Annual Results
22 | P a g e
© 2021 National Association of Insurance Commissioners
ACCIDENT AND HEALTH
Table 5 illustrates the insurance industry’s aggregate direct A&H insurance experience for insurers filing the A&H Policy
Experience Exhibit on all financial statement types: life/A&H, health, and property/casualty.
The insurance industry reported a 7% ($67.2 billion) increase in direct earned A&H premium to $1 trillion and a 3% ($22
billion) increase in incurred claims in 2020. These increases are most evident on the Medicare and Medicaid lines of
business for the reasons described above. These lines, in total, represents 49.2% of total earned premium.
Medicare reported a 13.6% ($33.5 billion) increase in earned premium to $280 billion and a 9% ($18.3 billion) increase
in incurred claims to $225.6 billion.
Medicaid reported a 13.7% ($27.4 billion) increase in earned premium to $227.8 billion and an 8.7% ($15.4 billion)
increase in incurred claims to $192.3 billion.
The individual comprehensive line of business, represenng only 7.9% of total A&H business, reported an 11.2% ($8.2
billion) increase in earned premium to $81.2 billion and a 4.5% ($2.6 billion) increase in incurred claims to $60 billion.
The group comprehensive line of business, which represents 20.3% of total A&H business, recorded a 1.7% ($3.7
billion) increase in earned premium to $209.4 billion and a 4% ($7.1 billion) increase in incurred claims to $172 billion.
The total number of covered lives decreased 1.7% (16.8 million) to 984.1 million.
Decreases are shown in a 6.8% (19.5 million) decrease in accident only or accidental death & dismemberment (AD&D),
a 34.7% (7.5 million) decrease in Medicare Supplement, a 2.8% (5.3 million) decrease in Other A&H lines of business,
and a 6.4% (2.6 million) decrease in the group comprehensive line of business
These items were parally offset by a 17.3% (6.4 million) increase in Medicaid, an 8.2% (5.6 million) increase in limited
benefit, an 8.2% (5.2 million) increase in stop loss, a 5.9% (1.4 million) increase in other group health, and a 5.7% (1.2
million) increase in Medicare.
Line of
Business
% of Total
2020
Premium
Earned
2019
Premium
Earned
% Chg.
2020
Claims
2019
Claims
% Chg.
2020
Covered
Lives
2019
Covered
Lives
% Chg.
Comp - Individual
7.9%
$81,244
$73,058
11.2%
$60,027
$57,451
4.5%
11,130,104
10,541,013
5.6%
Comp - Group
20.3%
$209,414
$213,104
(1.7)%
$172,035
$179,124
(4.0)%
37,713,450
40,278,173
(6.4)%
Specified/Named Disease
0.6%
$6,408
$6,129
4.6%
$2,815
$2,774
1.5%
24,973,986
25,923,134
(3.7)%
Medicare
27.1%
$279,756
$246,237
13.6%
$225,638
$207,382
8.8%
22,115,544
20,915,417
5.7%
Medicaid
22.1%
$227,786
$200,343
13.7%
$192,336
$176,921
8.7%
43,344,364
36,938,467
17.3%
FEHBP
4.2%
$43,376
$42,585
1.9%
$39,110
$39,874
(1.9)%
8,213,651
8,734,822
(6.0)%
Limited Benefit
1.2%
$12,700
$14,286
(11.1)%
$9,366
$11,771
(20.4)%
74,230,925
68,611,136
8.2%
Disability Income
2.6%
$27,124
$27,841
(2.6)%
$20,256
$19,777
2.4%
87,700,029
87,829,849
(0.1)%
Long-term Care
1.5%
$15,422
$12,954
19.1%
$14,017
$13,783
1.7%
6,648,747
6,881,601
(3.4)%
Accident Only or AD & D
0.7%
$7,647
$7,515
1.8%
$2,691
$2,877
(6.5)%
265,947,161
285,435,379
(6.8)%
Dental
2.7%
$27,871
$28,753
(3.1)%
$18,886
$21,837
(13.5)%
76,808,717
76,662,617
0.2%
Medicare Supplement
3.2%
$32,728
$32,629
0.3%
$24,327
$26,216
(7.2)%
14,095,517
21,591,586
(34.7)%
Medicare Part D
1.5%
$15,772
$17,008
(7.3)%
$12,504
$13,033
(4.1)%
20,256,759
20,951,472
(3.3)%
Other Group Care
0.6%
$6,425
$6,128
4.8%
$5,334
$5,258
1.4%
24,988,806
23,603,093
5.9%
Stop Loss
2.5%
$25,864
$23,800
8.7%
$20,816
$19,420
7.2%
68,727,552
63,533,705
8.2%
Non-U.S. Policy Forms
0.1%
$1,528
$1,547
(1.3)%
$694
$811
(14.4)%
16,523,298
16,565,906
(0.3)%
Other Business
1.0%
$9,888
$9,806
0.8%
$6,890
$7,439
(7.4)%
180,711,493
185,970,398
(2.8)%
Total A&H Business
100.0% $1,030,954 $963,721 7.0% $827,741 $805,750 2.7% 984,130,103 1,000,967,768 (1.7)%
Note: Includes statement types Life, Health and Property & Casualty
($ In Millions - Except Covered Lives)
A&H Policy Experience Exhibit as of December 31, 2020
Table 5
U.S. Health Insurance Industry | 2020 Annual Results
23 | P a g e
© 2021 National Association of Insurance Commissioners
Health Industry Disclosure:
In some states the health industry is regulated by a Department other than the Department
of Insurance. Therefore, not all health insurers may be required to file financial statements with the NAIC.
Financial Regulatory Services Division
Financial Analysis and Examinations Department
Contacts:
Bill Rivers, Health Financial Analysis Program Manager
816.783-8142
Bruce Jenson, Assistant Director Solvency Monitoring
816.783.8348
Jane Koenigsman, Sr. Financial Analysis Manager
816.783.8145
Disclaimer
:
The NAIC 2020 Health Insurance Industry Analysis Report is a limited scope analysis based on the aggregated
information filed to the NAIC’s Financial Data Repository as of Dec. 31, 2020, and written by the Financial Regulatory
Services Department staff. This report does not constitute the official opinion or views of the NAIC membership or any
particular state insurance department.
