Prevalence And Profits Of Insurers In The Administrative Services Only Market Serving Self-Insured Employers, 2010-22

For 165 million nonelderly Americans, employers provide health insurance either by purchasing a fully insured plan or through self-insurance. By self-insuring, employers bear the financial risk for enrollees' health care spending and are accountable for plan management, either directly or by co...

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Bibliographic Details
Published in:Health affairs (Millwood, Va.) Vol. 43; no. 12; pp. 1655 - 1663T
Main Authors: Abraham, Jean M, Cook, Amanda C, Sirmans, E Tice
Format: Journal Article
Language:English
Published: United States The People to People Health Foundation, Inc., Project HOPE 01.12.2024
Subjects:
Administrative expenses
Contractors
Corporate profits
Economics
Employers
Federal employees
Fees & charges
Female
Health Benefit Plans, Employee - economics
Health Benefit Plans, Employee - statistics & numerical data
Health care
Health care expenditures
Health care industry
Health care policy
Health insurance
Health services
Humans
Insurance
Insurance Carriers - economics
Insurance commissioners
Insurance coverage
Insurance Coverage - statistics & numerical data
Insurance, Health - economics
Male
Market segments
Market shares
Markets
Nationalist movements
Prevalence
Profitability
Profits
Purchasing
Reporting requirements
Services
Third party
United States
United States
ISSN:0278-2715, 2694-233X, 2694-233X, 1544-5208
Online Access:Get full text
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Summary:For 165 million nonelderly Americans, employers provide health insurance either by purchasing a fully insured plan or through self-insurance. By self-insuring, employers bear the financial risk for enrollees' health care spending and are accountable for plan management, either directly or by contracting with a third-party administrator. Using National Association of Insurance Commissioners data, we demonstrate that insurers are deeply entrenched in the provision of administrative services only (ASO) contracts for self-insured employers. In 2022, insurers administered to nearly four times as many ASO enrollees as they covered in fully insured plans, with fifty-six insurer-based ASO contractors providing services for 118 million enrollees. The largest ASO contractors-CVS Group, Cigna Health Group, and Elevance Health Inc. Group-collectively served more than seventy million ASO enrollees and demonstrated less variable and stronger profitability relative to other ASO contractors. This study expands understanding of this increasingly important market for employer-sponsored insurance.
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ISSN:0278-2715
2694-233X
2694-233X
1544-5208
DOI:10.1377/hlthaff.2024.00359