Mark Farrah Associates (MFA), www.markfarrah.com, compared 2025 and 2024, 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 2025, the average medical expense ratio for the Individual segment was 93.2%, as compared to 85.3% the previous year.
  • For the Employer-Group Risk segment, the growth in medical expenses, which more than offset the increase in premiums, pushed the average medical expense ratio for this segment up to 89.7% for 2025, from 88% in 2024.
  • For Medicare Advantage, growth in medical expenses, which was greater than the increase in premiums, pushed the average medical expense ratio for this segment up to 91% for 2025, from 89.5% in 2024.
  • For Managed Medicaid, the increase in premiums offset the increase in medical expenses PMPM, pushing the medical expense ratio down to 90.8% in 2025.

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.

To read the full text of “Year-Over-Year Health Insurance Segment Profitability Trends“, visit the Analysis Briefs library on Mark Farrah Associates’ Health Coverage Portal™.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, ASO Employer Health plus and Health Plans USA™. For more information about these products, refer to the product pages and brochures available under the Our Products section of the website (www.markfarrah.com), or call 724-338-4100.

Also, for the latest insights about health plan enrollment trends and financial performance, visit the FREE MFA Healthcare Business Strategy Briefs on the MFA website.

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