Health Plan Weekly

Here’s how major U.S. health insurers performed financially in the fourth quarter of 2024. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.

Blue Shield of California inadvertently shared patients’ protected health information with Google Analytics for three years, the insurer revealed in a breach notification. Blue Shield used Google Analytics to track members’ website usage and discovered in February that it was configured in such a way that allowed some member data to be shared with Google Ads between April 2021 and January 2024. Affected information could include insurance plan name, type and group number; city; ZIP code; gender; family size; Blue Shield assigned identifiers; medical claim service date and service provider; patient name; patient financial responsibility; and Find a Doctor search criteria and results. No bad actors were involved in the breach, and the connection between Google Analytics and Google Ads has been severed, the company said. 

A federal court ruled that Premera Blue Cross in Washington discriminated against transgender teenagers by denying coverage of gender-affirming chest surgery. U.S. District Judge Thomas Zilly ruled on April 18 that denying coverage for chest surgery for female-to-male teens but approving it for cisgender minors violates the Affordable Care Act by “facially discriminating on the basis of sex.” The original lawsuit was filed by Lambda Legal and law firm Sirianni Youtz Spoonemore Hamburger on behalf of two transgender teens and their parents. 

UnitedHealth Group’s shares declined by more than 22% on April 17 after the release of its first-quarter 2025 earnings, which surprised investors and highlighted issues stemming from the Optum Health business and higher-than-expected Medicare Advantage utilization. The company lowered its adjusted earnings per share (EPS) guidance for the year to between $26.00 and $26.50, down from the previous range of $29.50 to $30.00.  

For the first quarter, UnitedHealth reported adjusted EPS of $7.20, which came in 1% below the Wall Street consensus, and $109.6 billion in revenue, which was 2% below the consensus. Meanwhile, the company had a medical loss ratio (MLR) of 84.8%, which was lower (better) than the 85.7% consensus. However, UnitedHealth said it expects the full-year MLR to be between 87% and 88%, up significantly from 85.5% for full-year 2024 and 100 basis points higher than its previous guidance. 

Health insurers, consumer advocates and other stakeholders are sounding off about the first Affordable Care Act marketplace rule proposed by the second administration of President Donald Trump. While the insurance industry voiced support for some proposals — like eliminating what it views as a problematic special enrollment period — other reviews of the Marketplace Integrity and Affordability Proposed Rule trended negative. 

“This proposed rule on so-called marketplace integrity would make coverage more expensive, would make coverage cover less, would make coverage harder to get on and stay on — and will ultimately leave more Americans uninsured, living sicker, dying younger, and one emergency away from financial ruin,” Families USA Executive Director Anthony Wright said during an April 9 press call held by the consumer advocacy group. 

SCAN Group and Sutter Health recently unveiled a new collaboration that aims to bring new Medicare Advantage (MA) plans to not-for-profit entities’ home state of California and eventually launch a joint venture. The partnership offers opportunities to enhance access and provide a more seamless member experience, with the potential for replication in other markets, an exec with SCAN tells AIS Health, a division of MMIT.  

SCAN Group, the parent company of MA insurer SCAN Health Plan, revealed the partnership on April 10. Pending CMS approval, SCAN will offer new MA products in Northern California with access to Sutter’s network of doctors, hospitals, urgent care clinics and more. The two companies also intend to create a joint venture MA health plan “in the near future,” according to the announcement.