Blue + Prime dominates Health Insurance Marketplace

Prime Blue Plans have more than 20% of the health insurance marketplace (HIM), and Prime has the largest share of its pharmacy benefit management (PBM) services nationally.

Blue Cross and Blue Shield plans dominate the federal health insurance marketplace (HIM), according to a recent report by the Robert Wood Johnson Foundation and the Urban Institute. Of the 8.9 million people who enrolled for coverage through HealthCare.gov in 2018, 47 percent chose a Blue Plan, according to the report.

“Blue Cross and Blue Shield is a strong, trusted brand, and many Blue Plans have done a great job serving the individual market,” says Steven Heavrin, Prime’s senior director of HIM programs.

As a result of our clients’ strength, Prime dominates the individual market as well. Of the 11.4 million people currently receiving individual coverage through plans on the state and federal exchanges, Prime serves 2.5 million members. Prime serves an additional 2.6 million people receiving coverage on the small group market, Steven says.

More than price

Silver plans, to which premium subsidies are tied, are far more popular than the bronze, gold or platinum options. The Robert Wood Johnson report — “Which Types of Insurance Are Marketplace Enrollees Choosing?” — notes that through 2018, national insurers “offered plans with the lowest silver-level marketplace premiums.” Yet, as a group, these plans came in a distant second, serving 27 percent of HIM enrollees in 2018.

“Brand recognition and benefit design are big factors in the individual market,” Steven says. “We work closely with clients to offer network and coverage options that serve their regions and meet their strategic goals.”

The report from the Urban Institute expects the individual market to increase for two reasons:

1. Higher unemployment
2. Falling rate of employer-based health care due to economic uncertainties caused by COVID
   The report’s data sources are from 2018. Market shifts following 2018 will take into account these impacts.

Steven notes that the individual market has evolved since 2018. After shying away in the early years, more plans entered the market in 2019 and 2020. And the impact of the coronavirus remains uncertain. “With millions of people furloughed or laid off, the on-exchange market is a safety net for those who lose employer-based coverage,” Steven says. Many of them will choose a Blue Plan.”

Each Blue Cross® and/or Blue Shield® plan is an independent licensee of the Blue Cross and Blue Shield Association.