Analyses Highlight Profitability of Private Medicare, Medicaid Plans

By the end of 2021, gross margins per enrollee in the Medicare Advantage market had returned to pre-pandemic levels, and were significantly higher than gross margins in other health insurance markets, according to a recent Kaiser Family Foundation analysis. In 2021, gross margins for MA plans averaged $1,730 per enrollee, more than double the margins in the individual market ($745), the fully insured group ($689) and the Medicaid managed care market ($768). Gross margins for the individual market and group markets were 36% and 17% lower, respectively, in 2021 than they were in 2019, whereas the gross margins per enrollee for Medicaid managed care plans were higher in 2021 than pre-pandemic.

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Jinghong Chen

Jinghong Chen Reporter

Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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