Florida Blue has third-highest share in national insurance markets, study finds


Nicole Pasia


Blue Cross Blue Shield of Florida (BCBS FL/Florida Blue), the state’s largest insurer, tops its competitors in several national insurance markets, according to a recent study by the American Medical Association (AMA). The study analyzed data from 384 metropolitan statistical areas (MSAs) across all 50 states and the District of Columbia.


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The study used 2020 data from health care consultant Clarivate (formerly Decision Resources Group). They found that 73% of metropolitan statistical areas in (MSAs) the country had “highly concentrated” insurance markets. The majority of these markets (91%) had a commercial insurer with at least a 30% market share. 

Florida Blue tied with Minnesota-based UnitedHealth Group as the third-highest insurer, having each topped 22 MSAs. Anthem ranked first with 80 MSAs, while Health Care Service Corp. came in second with 44 MSAs. 


Image: American Medical Association


On Sept. 21, the Florida Office of Insurance Regulation (FOIR) released monthly premiums for plan year 2022. FOIR also provided a breakdown of insurance market availability by county. In the individual market, Florida Blue was the only plan with a presence in all 67 county markets. Celtic Insurance Company followed with a presence in 61 county markets. 

According to the AMA study, a higher concentration of insurers may lower market competition and allow existing insurers to have more control of the market.

According to FOIR, Florida Blue and Celtic Insurance Company had the highest premium increases of the 14 companies assessed, at 9.8% and 9.9%, respectively. Both rates exceeded the average increase of 6.6%.  


Image: Florida Office of Insurance Regulation


Markets with higher insurance concentration are becoming more common, according to the AMA study. The percentage of highly concentrated markets has increased slightly from 71% in 2014 to 73% in 2020. Mergers and acquisitions are partly responsible, the study said.

“Conceptually, mergers and acquisitions can have beneficial and harmful effects on consumers. However, only the latter has been observed. It appears that consolidation has resulted in the possession and exercise of health insurer monopoly power—the ability to raise and maintain premiums above competitive levels— instead of the passing of any benefits obtained through to consumers.”

The study also said market concentration can increase when barriers prevent new insurers from entering a market. These may include state regulatory requirements and provider network costs. 

Current regulatory statutes on insurance companies seeking to do business in Florida, finances, and other areas are under the Florida Department of Financial Services section of the Florida Administrative Code and Florida Administrative Register.

On Aug. 24, Florida Blue’s parent company GuideWell Mutual Holding Corporation announced a $900 million acquisition of Triple-S Management, a San Juan, Puerto Rico-based entity. GuideWell and Florida Blue CEO Pat Geraghty said the move is a “natural next step” for both companies. 

“The transaction expands GuideWell’s core insurance operations and positions Florida Blue and Triple-S Management for significant growth and meaningful value creation for the customers and communities we serve. 

Florida Blue and Triple-S Management are both recognized for their high-quality, affordable health care and their actions deeply rooted in supporting community well-being. With Puerto Rico’s outlook strengthening, and Florida experiencing fast-paced growth, especially in its Puerto Rican and Hispanic populations, this is a natural next step.”

The acquisition is currently subject to state and federal regulatory and review. If approved, the deal will close in the first half of 2022.