Becker's Healthcare September 25, 2025
Regional, nonprofit health plans are falling behind large national insurers, with 71% recording an operating loss in 2024 and more than half having two years or less before regulatory intervention is triggered, according to a Sept. 24 report from HealthScape Advisors.
“Executives and boards of directors now face the most important decision of their leadership tenures: How do we survive?” the report said.
Five notes:
1. Over the past three years, operating margins for regional payers have steadily declined as pricing pressures from employers and regulators intensify. Unlike their national peers, regionals have struggled to offset headwinds through diversification or scaling.
2. Regional and BCBS plans are reporting higher administrative loss ratios and medical loss ratios compared to national peers....
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