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Mark Farrah Associates (MFA), www.markfarrah.com, compared 2Q24 and 2Q25, per member per month (PMPM) health premiums and expenses for the Individual, Employer-Group, Medicare, and Medicaid segments. Financial insights were gleaned from aggregated statutory financial data from MFA’s Health Coverage Portal™.
For 2Q25, the average medical expense ratio for the Individual segment was 86.7%, as compared to 80.4% in 2Q24.
For the Employer-Group Risk segment, growth in premium was outpaced by the increase in medical expenses, moving the average medical expense ratio for this segment up to 86.6% for 2Q25, from 84.3% in 2Q24.
For Medicare Advantage, growth in medical expenses, which was greater than the increase in premiums expenses, pushed the average medical expense ratio for this segment up to 88.5% for 2Q25, from 88.3% in 2Q24.
For Managed Medicaid, increase in premiums PMPM fell behind the increase in medical expenses PMPM, pushing the medical expense ratio up to 92.1% in 2Q25.
Market analysts throughout the industry rely on enrollment data and segment performance metrics to gain better insights into health plan market share and competitive positioning. Mark Farrah Associates maintains financial data as well as enrollment and market share for the health insurance industry in its subscription-based Health Coverage Portal™. MFA will continue to monitor health plan performance and competitive shifts across all healthcare segments.
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