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Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets

Issue Brief
  1. As of 2016, states must define small group as 1-100 employees (and large groups as having 101 or more employees). Prior to 2016, however, states were allowed to continue to define small groups as having a maximum of 50 employees.

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  2. These figures are extrapolated based on enrollment in the plans included in this analysis, which do not represent the full enrollment of the private insurance market. Enrollment figures do not include plans that do not file data with the NAIC, plans licensed as life insurance, California HMOs regulated by California’s Department of Managed Health Care, plans that recorded negative premiums, claims, or enrollment numbers, or plans domiciled outside of the U.S.

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Methods
  1. 61% of workers with employer-sponsored insurance are enrolled in a plan that is completely or partially self-funded. This analysis only includes fully-insured group plans.

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