Elevance Health says it is now the largest insurer in the US, overtaking UnitedHealthcare. Analysts say it’s not that simple.

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Elevance Health says it has secured its spot as the largest U.S. insurer, covering more people than UnitedHealthcare.

For the past six quarters, Elevance’s financial statements show it provided medical coverage to more people in the U.S. than UnitedHealthcare, a longtime health care giant.

CEO Gail Boudreau said Wednesday that the latest count “solidifies” Elevance’s position as the largest U.S.-based medical membership insurance carrier.

Elevance reports that it insures more people in the US than UnitedHealthcare

The number of insured persons, including Elevance BlueCard members

But some analysts aren’t crowning Elevance the #1 title just yet. Which company should be considered the largest insurance carrier depends on how members are counted, they say.

Elevance Health ended the third quarter with 47.2 million members, including BlueCard members, while UnitedHealthcare covered 45.9 million people in the U.S.

Elevance has 6.5 million BlueCard members. Dean Ungar, senior analyst at Moody’s Investors Service, does not count those members toward Elevance’s total.

“It’s double counting — in a way,” Ungar told Healthcare Dive.

Brad Ellis, an analyst at Fitch Ratings, also does not count BlueCard members because members belong to Elevance’s Blue Cross Blue Shield plans.

Elevance is still the second largest insurer in the country, excluding BlueCard members

The number of insured, excluding BlueCard members

Elevance’s BlueCard system allows members of one Blue Cross Blue Shield plan to access BCBS plan provider networks in other states. Members may live in Ohio but are employed by a company that owns a plan written in Florida, Ellis said. In this example, they use the BlueCard network, but are a member and considered a policyholder of the Florida plan.

Elevance accounts for these members as they perform administrative functions for the member plans, such as claims pricing. Elevance also collects fees from BlueCard members’ home plan.

Elevance Health ended the third quarter with 47.2 million members, including BlueCard members, while UnitedHealthcare covered 45.9 million people in the U.S.

“The Indianapolis-based insurer’s membership growth continues to be impressive after overshadowing [UnitedHealthcare] total members over the past 12 months,” Jefferies analyst David Windley said in a recent note.

Either way – including BlueCard members or not – it’s a win for Elevance.

“However, this is good news for them,” Ungar said. “They are more dynamic. They are much more competitors. [CEO Gail Boudreaux] deserves a lot of credit for that.”

The six largest insurance companies in the country

US medical enrollment by insurer

Medical enrollment except for BlueCard members

Elevance, formerly known as Anthem, surpassed UnitedHealthcare’s local medical enrollment for the first time in the second quarter of 2021 as the country emerged from a winter surge in COVID-19 cases and hospitalizations.

Insurers are seeing enrollment surge amid the pandemic thanks to federal policies designed to protect Americans from losing coverage amid the public health emergency.

Medicaid growth has ballooned since 2020. States are prohibited from kicking Medicaid enrollees out of the program during a public health emergency.

About 82 million people had Medicaid coverage in June 2022, a 30 percent increase from February 2020, according to CMS.

Many insurers contract with states to cover their Medicaid enrollees, and many insurers have seen their Medicaid numbers increase during the pandemic.

Elevance now insures about 11 million Medicaid members, a 49% increase from the first quarter of 2020.

However, analysts expect enrollments to decline for insurers once the public health emergency ends and states can resume phasing out ineligible Medicaid members.

Plus, with a potential U.S. recession on the horizon, the resulting job losses could reduce the number of insurers that generate revenue from selling health insurance to employers of all sizes. About half of the US population relies on employer-based insurance for coverage.

Boudreau said Wednesday that the company is preparing for a possible recession.

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