california C A LIFORNIA HEALTHCARE FOUNDATION Health Care Almanac California Health Plans and Insurers

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1 california Health Care Almanac C A LIFORNIA HEALTHCARE FOUNDATION october 2010

2 Introduction Health insurance carriers form the backbone of California s market-based health care system, serving about two-thirds of the state s population. In addition to covering the privately insured, these companies also serve large portions of the publicly insured, through Medi-Cal, Healthy Families, Medicare, and other programs. In California, oversight of health insurance is primarily the responsibility of two entities: the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). DMHC regulates health plans health maintenance organizations (HMOs) and certain preferred provider organizations (PPOs) while CDI has jurisdiction over traditional fee-for-service health insurers and most PPOs. Different statutes and regulations govern carriers under the two bodies. Larger companies typically operate a carrier under each regulator, selling products under a common brand name. Drawing on comparable information from both regulators when available, this report gives an overview of market share, enrollment, financial performance, consumer satisfaction, and pay-for-performance participation for California s health plans and insurers. Key findings include: Five carriers accounted for three-fourths of the $100.8 billion health insurance revenues in California in contents Overview...3 Financials...9 Enrollment Customer Satisfaction Pay for Performance Data Resources...33 Appendices Since 2007, enrollment in both DMHC- and CDI-regulated plans has fallen. The onset of recession may have been a factor in the decline. Individual enrollment fell by 32 percent and group enrollment fell by 8 percent in the largest DMHC-regulated plans during 2008 and These losses were partially offset by increases in public programs. CDI-regulated plans are becoming increasingly important sources of revenue and revenue growth, as illustrated by Anthem and Blue Shield. Evidence points to an ongoing migration from carriers DMHC-regulated products to their CDI-regulated ones, which are generally slimmer, especially in the individual market where economic pressures are strongest. Despite enrollment losses, most plans were profitable in All of the largest DMHC plans operated in the black, as did almost all of the largest CDI-regulated insurers. Over half of all Medi-Cal and more than one-third of Medicare beneficiaries are enrolled in managed care plans. Large majorities of HMO and PPO members rate their plan highly in terms of getting appointments quickly, finding a doctor, and getting the care they need California HealthCare Foundation 2

3 Health Insurance Coverage, by Source, California, Overview About two-thirds of Californians have coverage through health insurance carriers. This includes Other Public* 1% Medicare 9% 3% enrolled in managed care Uninsured 19% Employer 49% 9% self-insured 55 percent with employerbased or individual private insurance, as well as 11 percent who are enrolled in Medicare and Medi-Cal Medi-Cal 17% 8% enrolled in managed care managed care plans. Individual 6% *Other Public includes Department of Defense and Veterans Administration coverage such as Tri-Care. Notes: SCHIP and individuals eligible for Medicare and Medi-Cal are included in Medi-Cal. For the 9 percent of Californians covered by self-insured employers, carriers provide administrative services only. Numbers may not add to 100 percent due to rounding. Source: Kaiser Family Foundation, State Health Facts, based on Census Bureau s Current Population Survey, Annual Social and Economic Supplements, 2008 and California HealthCare Foundation 3

4 All Health Insurance Carriers, by Share of Revenue, 2009 total: $100.8 billion dmhc: $83.5 billion (distribution on page 7) CDI: $17.3 billion (distribution on page 8) Overview Health insurance was a $100.8 billion business in California in Five players dominated the United 2% Aetna 4% PacifiCare 7% All Others 20% Kaiser* 32% state s health insurance market, accounting for some three-fourths of all revenues. Blue Shield 10% Health Net 10% Anthem Blue Cross 15% *Kaiser figures adjusted to reflect only California business. All Others includes Connecticut General (CIGNA), SCAN, L.A. Care, CalOptima, Contra Costa Health Plan, Care1st. Notes: Share computation based on: 1) total revenues from DMHC-regulated carriers; and 2) CDI California direct premium revenues reported by CDI for the Accident and Health line of business. Figures may not add to 100 percent due to rounding. UnitedHealthcare, PacifiCare Life and Health Insurance Company, and PacifiCare of California are members of the same holding company. Sources: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data; California Department of Insurance (CDI): California Life and Annuity Market Share Report for Calendar Year 2009, Exhibit 4D, and Table No. 1b Health California Direct Premiums Written, California HealthCare Foundation 4

5 Health Insurance Regulators Overview Department of Managed Health Care (DMHC) California Department of Insurance (CDI) Number of health insurance carriers regulated, , California revenues* regulated, ,2 $83.5 billion $17.3 billion Share of business represented by the largest 8 companies (largest as determined by revenues) Total enrollees reported, 2009 (DMHC), 2008 (CDI) 2,3 87% 66% 21.6 million (~59% population) 2.4 million (~7% population) Share of individual market enrollment, % 52% Share of group market enrollment, % 9% Primary types of health insurance products regulated HMOs, two PPOs, vision, dental Most PPOs, indemnity, Medicare supplements, Medicare Part D standalone, dental, stop-loss Health insurance carriers are regulated either by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI). The DMHC, which has more comprehensive benefit requirements, regulates HMOs, while the CDI oversees most PPOs and traditional fee-for-service plans. *Reflects total revenues for DMHC-regulated carriers and California premiums written for CDI-regulated carriers for the Accident and Health line of business. Notes: Certain Anthem Blue Cross and Blue Shield PPO products are regulated by DMHC; others are regulated under CDI. For additional details, see Making Sense of Managed Care Regulation in California, California HealthCare Foundation, November 2001 ( Number of carriers under DMHC reflects full service plans enrollment at fiscal year-end Six additional DMHC plans did not have enrollment at this time: San Miguel Health Plan, Premier, Talbert Health Plan, Choice Physicians Network, Golden State, Humana (all but Talbert and San Miguel had enrollees by the end of the first quarter 2010). Also excluded from the count: the DMHC-licensed medical discount plan, Association Health Care Management, Inc., dba Family Care (enrollment 20,232 at December 31, 2009). Sources: 1. CDI Reports: California Life and Annuity Market Share Report for Calendar Year 2009, Exhibit 4D; Table No. 1 Life California Direct Premiums Written, 2009; Table No. 1b Health California Direct Premiums Written, DMHC, Health Plan Financial Summary Data, Full Service Health Plans, CDI Office of Communications, 2008 figure is the most recent available. 4. California Health Benefits Review Board, Table 1 Health Care Coverage of Californians, California HealthCare Foundation 5

6 25 20 Health Insurance Carrier Enrollment Trends, DMHC and CDI, 2003 to 2009 in millions N/A 21.6 CDI DMHC Overview In 2008, enrollment in both DMHC and CDI plans declined. The onset of the recession at the end of 2007 may have been a factor in the decline Enrollment Growth CDI 14.1% 49.2% 3.0% 26.7% 12.0% N/A DMHC 1.7% 1.3% 1.4% 1.0% 2.1% 0.7% Notes: Percentage growth may not compute precisely from rounded figures shown. DMHC enrollment totals are estimated to be consistently overstated by some 600,000 to 1 million Medi-Cal enrollees each year (800,000 in 2009) because some plans contract enrollment out to other plans. CDI enrollment data for 2009 were not available. Sources: California Department of Insurance (CDI) Public Affairs Office; Department of Managed Health Care (DMHC) Health Plan Financial Statement Summary Data California HealthCare Foundation 6

7 DMHC-Regulated Health Plans, by Total Revenue, 2009 in millions total: $83.5 billion Overview Kaiser had by far the largest total revenues, consistent SCAN 2% ($1.7) Aetna 2% ($1.9) L.A. Care 1% ($1.2) PacifiCare 8% ($7.1) Blue Shield 10% ($8.5) All Others 13% ($10.6) Kaiser* 39% ($32.5) with an enrollment nearly twice that of the next-largest DMHC-regulated carrier. Other factors, including the possibility of more comprehensive benefits, may also contribute to its revenue share. Health Net 11% ($8.8) Anthem Blue Cross 13% ($11.1) *Kaiser figures adjusted to reflect only California business. All Others consists of 41 plans, including Heritage, CalOptima, Cigna, Care1st, Inland Empire, CareMore, Molina, Primecare, and Central California Alliance. See Appendix D for more detail. Notes: In addition to enrollment, other factors influencing revenue for health plans include comprehensiveness and price of products sold, enrollment levels in Medicare Advantage, and whether copays are also plan revenues, as in the case of staff model HMOs. Figures may not add to 100 percent due to rounding. Source: Department of Managed Health Care (DMHC) Health Plan Financial Summary Data California HealthCare Foundation 7

8 CDI-Regulated Health Insurers, by Premium Revenue, 2009 in millions total: $17.3 billion Overview Anthem Blue Cross is the dominant CDI-regulated insurer, with over twice the CT General (CIGNA) All Others 34% ($5,875) Blue Shield 7% ($1,230) Anthem Blue Cross 25% ($4,283) Aetna United* 10% ($1,673) 3% ($591) PacifiCare* 10% 2% ($267) ($1,659) Metropolitan 4% ($636) Health Net 6% ($1,087) premium revenue of any competitor. Blue Shield, Aetna, and Anthem have increased their share of the market in the last two years. With the top plans accounting for about twothirds of the revenue, the CDI-regulated market is less concentrated than DMHC s. *UnitedHealthcare and PacifiCare belong to the same parent company, United Health Group. All Others comprises 278 smaller carriers (as determined by their presence in California), including Guardian Life, American Family Life, Unum Life, and Humana, each writing less than $500 million in premiums in California. Note: Figures may not add to 100 percent due to rounding. Source: CDI Reports: California Life and Annuity Market Share Report for Calendar Year 2009, Exhibit 4D; Financial Reports, Table No. 1b Health California Direct Premiums Written, Not shown California HealthCare Foundation 8

9 Net Income/Loss as a Percent of Total Revenue, Largest DMHC Plans, 2007 to 2009 Financials In 2009, all large plans 2.1% Kaiser PacifiCare 3.2% 4.9% 4.2% 4.5% 5.8% posted positive net income, all below 5 percent. Earnings margins improved for five of the seven largest plans. Anthem Blue Cross 2.6% 4.0% 6.1% Aetna 2.5% 6.3% 6.4% Health Net 1.3% 2.0% 2.3% Blue Shield 2.1% 1.7% 9.0% 1.3% 0.3% L.A. Care 0.7% Notes: Net income is an after-tax figure. Kaiser data reflect multi-state business. All figures reflect fiscal year end results. Largest plans were selected on the basis of enrollment at December, Source: Department of Managed Health Care (DMHC) Health Plan Financial Summary Data California HealthCare Foundation 9

10 Net Income/Loss as a Percent of Total Revenue, Selected CDI Insurers, 2007 to 2009 Financials Margins declined for most PacifiCare Connecticut General (CIGNA) 9.8% <0.1% 8.7% United Aetna 5.7% 5.5% 6.6% 5.4% 7.6% 9.9% 18.8% 25.5% 25.1% CDI-regulated insurers from 2008 to 2009, with one company, Blue Shield, posting a loss. PacifiCare s earnings resulted from significant non-premium revenues.* Health Net 2.4% 1.0% 4.5% Anthem Blue Cross 5.0% 4.0% 10.9% Blue Shield 4.7% 0.4% 5.1% Notes: Net income is an after tax-figure; margin computed as line 35/line 9, Summary of Operations. Anthem Blue Cross and Blue Shield figures represent California business only; results for other insurers include business in multiple states Source: California Department of Insurance (CDI), Insurers Annual Statements, *PacifiCare s 2009 royalty income of $133 million from Secure Horizons and PacifiCare service marks exceeded its net income of $121 million. Pacificare has been been owned by United s parent since December California HealthCare Foundation 10

11 Revenue for Selected Carriers, DMHC and CDI, 2003 to 2009 Financials CDI-regulated plans are 16 in billions CDI DMHC becoming increasingly important sources of revenue and revenue < growth, as illustrated by Anthem and Blue Shield. Evidence points to an ongoing migration from carriers DMHC-regulated products to their CDIregulated ones, which are generally slimmer, especially Anthem Blue Cross Blue Shield CDI as a percent of Total revenue 12% 15% 17% 20% 22% 26% 28% 1% 1% 3% 4% 6% 9% 13% in the individual market where economic pressures are strongest. Notes: Carriers under CDI refers to Blue Shield of California Life and Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company. Carriers under DMHC refers to California Physicians Service, dba Blue Shield of California and Blue Cross of California, dba Anthem Blue Cross. Revenues reflect California accident and health premiums written for CDIregulated insurers and total revenues for DMHC-regulated plans. Percentage growth may not compute precisely from rounded figures shown. Source: Department of Managed Health Care, Health Plan Financial Summary Data; California Department of Insurance, California Life and Annuity Market Share Report, , Exhibit 4D California HealthCare Foundation 11

12 Revenue Growth/Contraction, Largest DMHC Plans and CDI Insurers, 2007 to 2009 DMHC Aetna 7% Kaiser 10% 1% 12% L.A. Care 3% 2% 11% 21% Blue Shield 3% <1% 5% 23% CDI Blue Shield Aetna United 12% 17% 24% 24% 23% Anthem Blue Cross 20% 13% 12% 40% 59% 60% 61% Financials Generally, revenue growth has been faster under CDIregulated plans. For some carriers, revenues under DMHC regulation have been shrinking. PacifiCare s revenue has contracted under both regulators. Health Net 13% 10% 3% Health Net 21% 6% 4% 4% Anthem Blue Cross 2% 1% Connecticut General (CIGNA) 32% 15% 13% 5% 7% PacifiCare 8% 24% 37% 34% PacifiCare Notes: Figures reflect total revenue for DMHC-regulated carriers. For CDI-regulated carriers, revenues reflect Accident and Health direct premiums written in California (Schedule T). All figures shown represent revenue growth in California, except Kaiser, whose figures include multi-state activity. Largest plans were selected on the basis of enrollment at December, Sources: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data; California Department of Insurance (CDI), Insurers Annual Statements California HealthCare Foundation 12

13 Share of Premium Dollar Spent on Medical Care, 2009 Financials DMHC 88% 87% CDI 84% 78% 88% 81% 88% 85% 94% 86% 79% 83% 97% 85% Medical care costs as a percent of premium revenues vary. They are influenced by factors such as risk levels, health plan profitability, tax status, 60 administrative efficiency, and medical practice 40 patterns. Most of the large DMHC-regulated 20 plans spend more of their premium dollar on medical 0 Aetna Anthem Blue Cross Blue Shield Health Net N/A Kaiser PacifiCare N/A United CT General (CIGNA) care than do large CDI-regulated plans. Notes: Medical care costs as a share of premium are referred to as loss ratios. The loss ratio for accident and health business, as computed in CDI annual statements: incurred claims and cost containment expenses plus increase in contract reserves divided by premiums earned (Schedule H, line (5+6)/line 2; Five-Year Historical Data; Anthem figure only from Accident and Health Policy Experience Exhibit). Medical loss ratio as computed under DMHC: total medical and hospital expenses divided by operating revenues; line 24 divided by the sum of lines 1 to 7 from Report #2 of DMHC financial reporting form. Loss ratios for Kaiser and for three CDI-regulated insurers (Health Net, PacifiCare, and Aetna) reflect multi-state activity. See Appendix F for loss ratios from 2003 to 2008 YTD. Figures aggregate across lines of business, such as group and individual. Sources: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data; California Department of Insurance (CDI), Insurers Annual Statements California HealthCare Foundation 13

14 Loss Ratios for Selected Individual and Group Products, CDI Insurers, 2007 to 2009 Individual Anthem Blue Cross 67% 67% 72% Financials Anthem Blue Cross and Blue Shield spent less of the premium dollar on medical care for individual coverage Blue Shield 70% 70% 69% than small group insurance. Loss ratios have climbed for Small Group Anthem Blue Cross 69% 76% 80% most of these insurers and product lines in Blue Shield 68% 82% 96% All Groups Anthem Blue Cross 74% 77% 82% Blue Shield 69% 81% 95% Note: Loss ratios are for comprehensive medical insurance: incurred claims plus change in contract reserves divided by premiums earned. Source: California Department of Insurance (CDI), Insurers Annual Statements (Accident and Health Policy Experience Exhibit) California HealthCare Foundation 14

15 Administrative Ratios, 2009 Financials Blue Shield 11.3% Anthem Blue Cross Health Net Aetna PacifiCare Kaiser L.A. Care Blue Shield Anthem Blue Cross Health Net* PacifiCare* United* CT General (CIGNA)* Aetna* 10.2% 10.0% 9.6% 6.6% 4.2% 4.1% 14.5% 13.9% 13.3% 8.9% 8.0% 6.4% 21.7% DMHC CDI The administrative ratio is the share of revenues spent on activities such as contracting with providers, processing claims, marketing, and commissions. Higher ratios can reflect inefficiencies or a small premium base over which to spread administrative costs. *Figures reflect multi-state business Notes: Administrative percentages reflect the share of revenues spent on administrative expenses. Administrative ratio as reported by DMHC: total administration expenses / total revenue. Insurance expense percent as reported on CDI filing, Five Year Historical Data (line 60 for all carriers except Anthem; line 8/line 5 for Anthem s Health filing version of the document). Sources: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data; California Department of Insurance (CDI), Insurers Annual Statements California HealthCare Foundation 15

16 Dividends to Stockholders as a Percent of Revenue, 2009 Financials In 2009, dividends to DMHC CDI 16.4% stockholders in California s major carriers ranged from zero to 16 percent. 4.7% 5.2% 2.7% 0.9% 0.9% 1.3% 2.7% 3.1% 4.0% Health Net PacifiCare Anthem Blue Cross Aetna Aetna* CT General (CIGNA)* Health Net* Anthem Blue Cross United* PacifiCare* *Figures reflect multi-state business. Notes: CDI-regulated insurers: Blue Shield paid no dividend. DMHC-regulated plans: nonprofits Kaiser and Blue Shield paid no dividends in Source: Department of Managed Health Care (DMHC), Health Plan Financial Reporting Forms; California Department of Insurance (CDI), Insurers Annual Statements California HealthCare Foundation 16

17 Enrollment Trends in DMHC-Regulated Plans, Year-End 2003 to 2009 Total Enrollment (in millions) Change since RECESSION ERA All Plans 1.4 million ( 6%) Kaiser +206k (+3%) Enrollment Enrollment in DMHCregulated plans has dropped 6 percent since the end of 2003 a loss of 1.4 million enrollees. The largest seven DMHC plans lost 9 percent All Others Anthem Blue Cross Blue Shield Health Net +255k (+6%) 1.2 million ( 25%) 100k ( 4%) 76k ( 3%) of their enrollment in this period, while smaller plans, which include many county-based plans serving Medi-Cal, grew. Enrollment losses may be attributed PacifiCare L.A. Care Aetna k ( 36%) +15k (+2%) +78k (+21%) to recession, post-merger activity, and migration to CDI-regulated plans. Notes: Plans shown are full-service DMHC plans with over 450,000 enrollees as of year-end PacifiCare reports merger-related activities have led to enrollment transfers to UnitedHealthcare; PacifiCare enrollment declined 17 percent in 2009 and 32 percent since year-end Largest plans were selected on the basis of enrollment at December, Sources: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data. National Bureau of Economic Research California HealthCare Foundation 17

18 Enrollment Gains/Losses, Largest DMHC-Regulated Plans, by Insurance Type, 2008 and 2009 Enrollment The seven largest plans Individual 130, ,461 Group 340,035 88,012 Medicare 41,518 48,490 Medi-Cal and Other Public 68,583 9,415 13,836 Other lost 1.3 million commercial enrollees during 2008 and 2009, while enrollment in Medicare and public plans grew slightly. The commercial losses represented 32 percent of individual enrollment 0000 and 8 percent of group enrollment , Overall Change (year-end 2007 to year-end 2009) 32% 8% + 9% + 4% 4% Notes: Some, but not all of these losses were offset by gains in the CDI sector (see page 20 of this publication). Other factors, such as a shift to self-insurance and administrative services only from carriers can also affect the accounting of enrollment. Other Public includes Healthy Families, Healthy Kids, and AIM. The seven largest plans reflected here are: Aetna, Anthem Blue Cross, Blue Shield, Health Net, Kaiser, L.A. Care, and PacifiCare. Largest plans were selected on the basis of enrollment at December, Source: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data and Report # California HealthCare Foundation 18

19 Source of Enrollment Gains/Losses, Selected DMHC-Regulated Plans, by Insurance Type, 2007 to 2009 Net Change Individual Group Medicare Public Other number percent Aetna 67,855 1,774 13,907 83,536 22% Anthem Blue Cross 164, ,231 8, , ,519 15% Blue Shield 92,518 55,558 84,536 15,873 62,339 1,110 0% Health Net 15, ,003 25, ,396 31,327 63,253 3% Kaiser 35, ,716 44,090 69,021 47, ,601 2% L.A. Care ,445 34,870 43,955 6% PacifiCare 7, ,169 18, ,832 32% Enrollment Most enrollment gains were concentrated in the public sector. Anthem and Blue Shield accounted for the bulk of individual enrollment losses, and PacifiCare accounted for almost half of the losses in group enrollment. Total, Plans Shown 315, , , ,073 4,421 1,047,098 6% Notes: Other includes plan-to-plan enrollment; Group includes small group, point of service, and administrative services only. (Administrative services only accounted for 11 percent of Anthem Blue Cross and 24 percent of Blue Shield s DMHC group enrollment in 2009.) Largest plans were selected on the basis of enrollment at December, Source: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data and Report # California HealthCare Foundation 19

20 Enrollment Trends in Selected CDI-Regulated Insurers, Group and Individual, 2007 to 2009 Enrollment Individual purchasers ,280, ,015 1,307, ,398 Group Individual have been a major factor in enrollment growth of CDI-regulated insurers. Individuals now account for 45 percent of Blue Shield and 51 percent of Anthem. Under CDI-regulation, ,848 86, , , , , , ,147 carriers can offer slimmer products to the pricesensitive individual market ,758 86, , , , , Anthem Blue Cross Blue Shield Notes: Reflects comprehensive major medical insurance enrollment; excludes administrative services only and administrative services contract enrollment of 2.84, 3.16, and 3.68 million for 2007, 2008, and 2009 respectively (Anthem Blue Cross). Blue Shield reported no ASO enrollment under CDI regulation. Source: California Department of Insurance (CDI), Insurers Annual Statements, Accident and Health Policy Experience Exhibit for Year California HealthCare Foundation 20

21 Commercial Enrollment Shifts, Group and Individual, Selected CDI and DMHC Carriers, 2007 to 2009 Enrollment In California s commercial Anthem 254,764 Blue Shield 169,673 Kaiser 253,351 Group Individual sector, growth in CDI products has not offset losses in the DMHCregulated products. Anthem, Blue Shield, and Kaiser experienced net commercial enrollment ,943 losses across CDI- and DMHC-regulated insurance ,359 35,550 Note: Enrollment refers to comprehensive major medical insurance. Sources: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data and Report #4; California Department of Insurance (CDI), Insurers Annual Statements, Accident and Health Policy Experience Exhibit for Year California HealthCare Foundation 21

22 Medicare Advantage vs. Medicare Fee-for-Service, California vs. United States, December 2009 Enrollment Almost two-thirds of California Medicare Eligibles Total: 4.6 million Medicare Advantage 35% Other Contracts <1% Fee-for-Service 65% Medicare Advantage 24% U.S. Medicare Eligibles Total: 46 million Fee-for-Service 76% Other Contracts 1% California s Medicare beneficiaries have fee-forservice coverage, and over one-third have Medicare Advantage. California s 35 percent participation rate in Medicare Advantage is higher than the national average of 24 percent. Notes: Under Medicare Advantage, health plans provide all Medicare benefits in exchange for a capitated payment. Other Contracts include cost contracts, which do not involve capitation, and PACE, the Program of All Inclusive Care for the Elderly, an alternative to nursing home care. Figures exclude pilot projects. Some Fee-for-Service (FFS) beneficiaries also have Medicare supplemental insurance. Figures may not add to 100 percent due to rounding. Source: Centers for Medicare and Medicaid Services, Medicare Advantage State/County Penetration and Medicare Advantage Enrollment by State/County/Contract, December California HealthCare Foundation 22

23 Medicare Advantage Enrollment, December 2009 Enrollment Kaiser and United together total Enrollment: 1.62 million cover two-thirds of all Blue Shield 3% Aetna 3% All Others* 10% Medicare Advantage members in the state. Anthem Blue Cross 4% SCAN 7% Health Net 8% Kaiser 45% United 21% *All Others includes Caremore Health Plan, Inter Valley Health Plan, Care 1st, CalOptima (Orange County Health Authority), Citizens Choice, Humana, Health Plan of San Mateo, Chinese Community Health Plan, and 42 other carriers. United s Medicare Advantage products are marketed under the name Secure Horizons by UnitedHealthcare and encompass the former PacifiCare Medicare Advantage enrollment. Note: Figures may not add to 100 percent due to rounding. Source: Centers for Medicare and Medicaid Services, Medicare Advantage Enrollment by State/County/Contract, December California HealthCare Foundation 23

24 Medi-Cal Fee-for-Service vs. Managed Care Enrollment, December 2009 Enrollment Over half of all Medi-Cal Fee-for-Service 47% Other Managed Care 12% L.A. Care 11% Anthem Blue Cross 6% Health Net 9% total Medi-Cal: 7.21 million managed care: 3.85 million (53% of beneficiaries) Molina 2% Central Coast Alliance for Health 2% Inland Empire 5% CalOptima 5% beneficiaries are enrolled in managed care. The total pool of Medi-Cal beneficiaries rose 6 percent in 2009.* Notes: Some Medi-Cal managed care plans contract their enrollees out to other managed care plans. Figures here reflect contracts between plans and the state. Figures may not total 100 percent due to rounding. Other Managed Care is detailed on Slide 25. Source: California Department of Health Care Services, Medi-Cal Managed Care Enrollment Report, December 2009 ( and Research and Analytical Studies Section Beneficiary Data Files, accessed June 2010 ( *Not shown California HealthCare Foundation 24

25 Medi-Cal Managed Care Market Share and Enrollment, by Health Plan, December 2009 Inland Empire Health Plan Central California Alliance for Health* Molina Partnership Kern Family Health Care* Santa Clara Family Health Plan* Alameda Alliance* Community Health Group CenCal* Health Plan of San Joaquin* Health Plan of San Mateo* Contra Costa Health Plan* L.A. Care* 20% 787,589 Health Net Anthem Blue Cross CalOptima* All Other Plans 18% 11% 9% 9% 4% 4% 4% 3% 2% 2% 2% 2% 2% 1% 1% 3% 172, , ,450 94,738 92,522 89,509 88,685 71,043 57,627 54, , , , , , ,853 Enrollment County-level plans play a major role in Medi-Cal s expanding managed care program, covering nearly 60 percent of the managed care enrollees. The state contracted for Medi-Cal managed care in 26 of California s 58 counties in *County plans. San Francisco Health Plan (included in All Other Plans) is also a county health plan Notes: All Other Plans consists of Kaiser, 40,206; San Francisco Health Plan, 36,009; Western Health Advantage, 13,451; Care1st, 10,049; Positive Healthcare, 716; Family Mosaic Project, 138. (Family Mosaic Project is a specialty health plan operated by San Francisco s Department of Public Health, serving emotionally disturbed children at risk of out-of-home placement, and is not a DMHC licensee.) Some Medi-Cal managed care plans contract their enrollees out to other managed care plans. Figures here reflect contracts between plans and the state. Source: California Department of Health Care Services, Medi-Cal Managed Care Enrollment Reports ( California HealthCare Foundation 25

26 Healthy Families Enrollment, December 2009 Enrollment Although some county total enrollment: 882,432 plans have sizable enrollments, California s major commercial carriers Kaiser 18% Other 17% Community Health Group* 3% insure the majority of Healthy Families members. Health Net 16% CalOptima* 5% Molina 5% Together, Health Net, Anthem, Kaiser, and Blue Shield cover 64 percent of Healthy Families enrollees. Anthem Blue Cross HMO 13% Anthem Blue Cross EPO 11% Inland Empire* 7% Blue Shield HMO 6% *County plans. Some of those included under Other are also county plans Notes: Other includes Kern Family Health Care, Blue Shield EPO (exclusive provider organization), Care1st, Alameda Alliance, San Francisco Health Plan, CenCal, L.A. Care, Health Plan of San Mateo, Contra Costa Health Plan, and Ventura County Health Plan. Healthy Families is California s vehicle for the State Children s Health Insurance Program (SCHIP) and, unlike Medi-Cal, has no fee-for-service component. Source: MRMIB Report: Healthy Families Program Current Enrollment Distribution by County and Health Plan, January 5, 2010 ( California HealthCare Foundation 26

27 HMO Members Highly Rating Their Care, 2009 Customer Satisfaction 80 The majority of HMO members rated the care % 68% 69% 70% 72% 73% 73% 73% in their plans highly Blue Shield HMO Anthem HMO Health Net CIGNA HMO Aetna PacifiCare Kaiser North Kaiser South Notes: Percent of plan members who rated their health care 8, 9, or 10 on a scale of 10. Differences of 4 percentage points or more should be considered meaningful. When there were an insufficient number of responses, no bar is shown. Source: Office of the Patient Advocate, 2009 surveys California HealthCare Foundation 27

28 Getting Appointments and Care Quickly, HMO and PPO Members, 2009 Anthem HMO 80% HMO PPO Customer Satisfaction More than three-fourths of enrollees rated their plan highly on access to care. PacifiCare Aetna Blue Shield HMO CIGNA HMO Kaiser North Health Net United Health Net Aetna Anthem PPO 81% 81% 81% 81% 84% 85% 84% 85% 85% 86% Notes: Percent of members who rated their plan 8, 9, or 10 on a scale of 10 on how quickly and easily they got care and service from their doctors and office staff. Differences of 4 percentage points or more should be considered meaningful. Source: Office of the Patient Advocate, 2009 surveys California HealthCare Foundation 28

29 Ease in Finding a Doctor They Are Happy With, HMO and PPO Members, 2009 Anthem HMO 69% HMO PPO Customer Satisfaction Many PPO and HMO enrollees rated their plans similarly in terms of making Blue Shield HMO Kaiser North Aetna PacifiCare Health Net Health Net United Anthem PPO Aetna 72% 73% 75% 76% 77% 74% 76% 77% 78% it easy to find a personal doctor they are happy with Notes: Percent of members who rated their plan 8, 9, or 10 on a scale of 10 on how easy it was to find a personal doctor they are happy with. Differences of 4 percentage points or more should be considered meaningful. Source: Office of the Patient Advocate, 2009 surveys California HealthCare Foundation 29

30 Getting the Care They Need, HMO and PPO Members, 2009 AnthemHMO 78% Kaiser South Blue Shield HMO Aetna Health Net Kaiser North PacifiCare CIGNA HMO Health Net CIGNA PPO AnthemPPO Aetna United 80% 81% 82% 83% 83% 84% 84% 82% 86% 87% 88% 90% HMO PPO Customer Satisfaction The large majority of enrollees rated their plan highly for helping them get the care they need Notes: Percent of members who rated their plan 8, 9, or 10 on a scale of 10 on helping them get the care they need. Differences of 4 percentage points or more should be considered meaningful. Source: Office of the Patient Advocate, 2009 surveys California HealthCare Foundation 30

31 Complaints Filed with DMHC, by Specific Issue, 2009 Claims/Financial Benefits/Coverage Coordination of Care Access Attitude/Service of Health Plan Attitude/Service of Provider Enrollment Anthem Blue Cross TOTAL NUMBER OF COMPLAINTS* Aetna Customer Satisfaction The complaint process provides another measure of satisfaction. Of the large commercial plans, Health Net had the lowest complaint rate. Blue Shield 799 Health Net 368 Kaiser 1,809 PacifiCare Complaints Per 10k Members *Companies with less than 500,000 enrollees were not charted. Total complaints for smaller plans was 129, including Inland Empire (3), L.A. Care (3), and Cigna (42). Note: Largest plans were selected on the basis of enrollment at December, Source: Department of Managed Health Care (DMHC), 2009 Complaint Results by Category and Health Plan California HealthCare Foundation 31

32 Pay for Performance, 2009 Pay for Performance per member per month (in dollars) total payment (in millions) Major HMOs are using $5 $4 Non-IHA Measures IHA Measures $4.53 $80 $70 $60 performance measurement and financial incentives to enhance clinical quality, patient experience, and $3 $2 $1 $1.02 $1.63 $1.70 $2.00 $2.27 $50 $40 $30 $20 $10 information technology. Plans make two types of incentive payments: those based on uniform measurements adopted by the Integrated HealthCare Association (IHA), and those $0 CIGNA United/ PacifiCare Aetna Health Net Blue Shield Anthem Blue Cross $0 based on plan-selected criteria. total payment (in millions) $3.0 $15.5 $7.4 $27.6 $29.5 $60.3 Notes: Kaiser Health Plan participates in the clinical reporting of IHA measures, but not in the financial payouts. Source: Integrated HealthCare Association, Transparency Report on 2009 Health Plan Payouts California HealthCare Foundation 32

33 Data Resources Regulators California Department of Insurance (CDI) Insurance Company Profiles, including Financial Statements Insurance Company Financial Reports, Table No. 1 Life California Direct Premiums Written, Table No. 1b Health California Direct Premiums Written, Life and Annuity Market Share Reports, California Department of Managed Health Care (DMHC) Health Plan Information, including Financial Statements Health Plan Financial Statements Licensed Plans List Health Plan Financial Summary Report wpso.dmhc.ca.gov Independent Medical Review and Complaint Results, Centers for Medicare and Medicaid Services Monthly Medicare Advantage Enrollment, by State/County/Contract Medicare Advantage State/County Penetration Report Other State Resources Note: All links current as of September 16, California Department of Health Care Services (DHCS) Medi-Cal Beneficiary Data Files Medi-Cal Enrollment, by Managed Care Plan, California Health Benefits Review Board (CHBRP) Table 1: Health Insurance Coverage of Californians, California Major Risk Medical Insurance Board (MRMIB). Information for Healthy Families, Aid to Infants and Mothers (AIM), Major Risk Medical Insurance Program (MRMIP), Monthly Board Meetings Minutes (link to monthly enrollment for Healthy Families, AIM, and MRMIP) California Office of the Patient Advocate Health Plan Report Cards opa.ca.gov Private Resources Integrated Healthcare Association (IHA) Financial Transparency Reports: Pay for Performance Payouts Kaiser Family Foundation State Health Facts for more information C A LIFORNIA HEALTHCARE FOUNDATION California HealthCare Foundation 1438 Webster Street, Suite 400 Oakland, CA California HealthCare Foundation 33

34 Appendix A: Affiliated Entities of California s Largest Health Insurance Carriers Appendices Company Grouping Under Department of Managed Health Care Under California Department of Insurance Aetna Aetna Health of California, Inc. Aetna Life Insurance Company Anthem Blue Cross Blue Cross of California, dba Anthem Blue Cross Anthem Blue Cross Life and Health Insurance Company Blue Shield California Physicians Service, dba Blue Shield of California Blue Shield of California Life and Health Insurance Company Careamerica Life Insurance Company* Cigna CIGNA HealthCare of California GEMCare Health Plan, Inc. Great-West Health Plan, Inc. Connecticut General Life Insurance Company* Health Net Health Net of California, Inc. Health Net Life Insurance Company Kaiser Kaiser Foundation Health Plan, Inc. * Kaiser Permanente Insurance Company* UnitedHealthcare PacifiCare of California PacifiCare Life and Health Insurance Company UnitedHealthcare Insurance Company* *Multi-state activities are included in California regulatory filings. Denotes entities paired under their company brand name in snapshot slides comparing or combining DMHC and CDI carriers. Note: Largest plans were selected on the basis of enrollment at December, Source: California Department of Insurance (CDI): California Life & Annuity Market Share Report, 2009; Annual Statements for the year ending 2009, Schedule Y California HealthCare Foundation 34

35 Appendix B: DMHC-Regulated Health Plans, December 31, 2009 Appendices Health Plan Name Official Health Plan Name Administrative Office Location Date Licensed SIZE (Enrollment) enrollment distribution Medi-Cal, AIM, Healthy Families Aetna Aetna Health of California, Inc. Walnut Creek 8/6/81 455,470 0% 6% B P Alameda Alliance Alameda Alliance For Health Alameda 9/19/95 107,894 94% 2% C NP Anthem Blue Cross 1 Blue Cross of California Thousand Oaks 1/7/93 3,552,695 28% 7% B P Arcadian Arcadian Health Plan, Inc. Oakland 5/29/08 28,958 n/a n/a M P Arta Arta Medicare Health Plan, Inc. San Diego 3/17/ % 100% M n/a Blue Shield 2 California Physicians' Service San Francisco 7/27/78 2,601,504 2% 5% B NP CalOptima Orange County Health Authority Orange 6/28/00 400,504 97% 3% C/B NP Care1st Care1st Health Plan Monterey Park 11/1/95 308,975 68% 4% O NP CareMore CareMore Health Plan Cerritos 11/1/02 33,860 0% 100% M P CenCal Santa Barbara San Luis Obispo Regional Health Authority Goleta 6/22/00 98,785 97% 0% C NP Central California Alliance for Health Santa Cruz-Monterey-Merced Managed Medical Care Community Scotts Valley 6/20/00 194,711 99% 0% C NP Central Health Plan Central Health Plan of California, Inc. Covina 10/27/04 4,953 0% 100% M P Chinese Community Health Plan Chinese Community Health Plan San Francisco 7/31/87 13,765 0% 55% O P CIGNA CIGNA HealthCare of California, Inc. Glendale 3/23/79 212,965 0% 0% O P CIGNA Pacific (previously Great-West) CIGNA HealthCare Pacific, Inc. Glendale 3/22/96 13,086 0% 0% O P Citizens Choice Honored Citizens Choice Health Plan, Inc. Cerritos 5/25/04 8,279 0% 100% M n/a Community Health Group Community Health Group Chula Vista 8/30/85 115,685 99% 1% C NP Community Health Plan County of Los Angeles Department of Health Services Alhambra 12/30/85 186,721 81% 0% C NP Contra Costa Health Plan Contra Costa County Medical Services Martinez 4/6/78 81,847 72% 1% C NP Easy Choice Easy Choice Health Plan, Inc. Newport Beach 6/11/07 5,337 0% 100% M P GEMCare GEMCare Health Plan, Inc. Glendale 3/22/96 6,467 0% 100% M n/a Health Net Health Net of California, Inc. Woodland Hills 2/7/97 2,161,960 45% 6% B P Health Plan of San Joaquin San Joaquin County Health Commission French Camp 1/30/96 101,066 88% 0% C NP Health Plan of San Mateo San Mateo Health Commission South San Francisco 7/31/98 76,162 81% 10% C NP 1. Includes 240,571 (7 percent of total) enrolled in administrative services only (ASO) contracts. 2. Includes 564,836 (22 percent of total) enrolled in ASO contracts. Key to Plan Types: B (Big): 400,000 or more enrollees; M (Medicare): 70 percent or more enrollees in Medicare; C (Medi-Cal): 70 percent or more enrollees in Medi-Cal, Healthy Families, AIM; O (Other): all others. Plan types determined based on status at December 31, Status based on enrollment reports, disclosures, and footnotes filed in health plan financial reports to DMHC. Key to Tax Status: P: for profit; NP: nonprofit or public health agency. Not Shown: Six plans with no enrollment at December 31, 2009 (plan type and March 31, 2010 enrollment shown in parentheses): Choice Physicians Network (M: 3,544), Golden State (M: 252), Humana (M: 514), Premier (M), San Miguel Health Plan (M), and Talbert Health Plans (O). Also not shown: The sole DMHC-licensed medical discount plan, Association Health Care Management, Inc., dba Family Care (enrollment 20,232 at December 31, 2009). Source: Department of Managed Health Care (DMHC), annual financial reports of full service health plans and List of All Licensed Plans (6/14/2010); supplemental information on tax status from the California Association of Health Plans 2009 Annual Report. Medicare Plan type Tax Status 2010 California HealthCare Foundation 35

36 Appendix B: DMHC-Regulated Health Plans, December 31, 2009, continued Appendices Health Plan Name Official Health Plan Name Administrative Office Location Date Licensed SIZE (Enrollment) enrollment distribution Medi-Cal, AIM, Healthy Families Heritage* Heritage Provider Network, Inc. Northridge n/a 455,846 3% 16% B P Inland Empire Inland Empire Health Plan San Bernardino 7/22/96 430,871 98% 1% C/B NP Inter Valley Inter Valley Health Plan Pomona 5/25/79 12,208 0% 100% M NP Kaiser Kaiser Foundation Health Plan, Inc. Oakland 11/4/77 6,659,879 5% 11% B NP Kern Family Health Care Kern Health Systems Bakersfield 5/6/96 101, % 0% C NP L.A. Care Local Initiative Health Authority for Los Angeles County Los Angeles 4/1/97 816,496 97% 0% C/B NP MD Care MD Care, Inc. Los Alamitos 7/6/07 7,245 0% 100% M n/a Medcore Medcore HP Stockton 6/26/02 2,098 M n/a Molina Molina Healthcare of California Long Beach 3/14/97 350,624 C P Monarch Monarch Health Plan Irvine 4/18/07 7,729 M n/a On Lok 3 On Lok Senior Health Services San Francisco 1/20/99 1,010 M/C NP PacifiCare PacifiCare of California Cypress 5/15/78 1,070,639 0% 30% B P Partnership Partnership HealthPlan of California Fairfield 11/4/05 156,413 96% 3% C NP Positive Healthcare AIDS Healthcare Foundation Long Beach 12/1/05 1,404 51% 49% O n/a Primecare* PRIMECARE Medical Network, Inc. Ontario 10/16/98 177,777 O P San Francisco San Francisco Community Health Authority San Francisco 5/23/05 57,561 75% 0% C NP Santa Clara Family Health Plan Santa Clara County Health Authority Campbell 12/20/96 122,678 90% 3% C NP SCAN Scan Health Plan Long Beach 11/30/84 111,114 6% 94% M NP Scripps* Scripps Health Plan Services, Inc. San Diego 4/7/99 35,854 O n/a Sharp Sharp Health Plan San Diego 9/18/92 47,406 O NP Simnsa Sistemas Medicos Nacionales, S.A.de C.V. Tijuana, Mexico 1/31/00 20,283 O P Universal Care Universal Care Signal Hill 10/15/85 15,841 C P Valley Health Plan Santa Clara County San Jose 9/13/85 71,426 C NP Ventura County Health Plan County of Ventura Ventura 6/6/96 13,491 27% 0% O NP Western Western Health Advantage Sacramento 1/14/97 83,068 16% 2% O P 3. On Lok operates under Medicare and Medicaid waivers as a prototype Program of All-inclusive Care for the Elderly (PACE), providing complete care to a nursing-home-certified population that remains in the community. *Limited license Knox-Keene Act plan. Permitted to assume full-risk for physician and hospital services, but contracts with other health plans for enrollment. Key to Plan Types: B (Big): 400,000 or more enrollees; M (Medicare): 70 percent or more enrollees in Medicare; C (Medi-Cal): 70 percent or more enrollees in Medi-Cal, Healthy Families, AIM; O (Other): all others. Plan types determined based on status at December 31, Status based on enrollment reports, disclosures, and footnotes filed in health plan financial reports to DMHC. Key to Tax Status: P: for profit; NP: nonprofit or public health agency. Not Shown: Six plans with no enrollment at December 31, 2009 (plan type and March 31, 2010 enrollment shown in parentheses): Choice Physicians Network (M: 3,544), Golden State (M: 252), Humana (M: 514), Premier (M), San Miguel Health Plan (M), and Talbert Health Plans (O). Also not shown: The sole DMHC-licensed medical discount plan, Association Health Care Management, Inc., dba Family Care (enrollment 20,232 at December 31, 2009). Source: Department of Managed Health Care (DMHC), annual financial reports of full service health plans and List of All Licensed Plans (6/14/2010); supplemental information on tax status from the California Association of Health Plans 2009 Annual Report California HealthCare Foundation 36 Medicare Plan type Tax Status

37 Appendix C: Selected CDI-Regulated Health Insurers,* Year-End 2009 Appendices Official Health Plan Name Name Used in publication Size (in millions) Aetna Life Insurance Company Aetna $1,659 Anthem Blue Cross Life and Health Company Anthem Blue Cross $4,283 Blue Shield of California Life & Health Insurance Company Blue Shield $1,230 Connecticut General Life Insurance Company Connecticut General (CIGNA) $591 Health Net Life Insurance Company Health Net $1,087 Metropolitan Life Insurance Company Metropolitan $636 PacifiCare Life and Health Insurance Company PacifiCare $267 UnitedHealthcare Insurance Company United $1,673 * CDI-regulated companies selling accident and health insurance, with California direct accident and health premiums greater than $400 million, PacifiCare also included due to its affiliation with UnitedHealthcare. State-specific enrollment is not available for companies with multi-state filings. Products include comprehensive major medical insurance, in addition to other products, such as dental, Medicare supplement, Part D standalone, and stop-loss. In millions of dollars of California accident and health premiums. Wholly owned subsidiary of CIGNA. Source: California Department of Insurance (CDI) Insurers Annual Statements, Schedule T; Accident and Health Policy Experience Exhibit California HealthCare Foundation 37

38 Appendix D: Financial Summary, DMHC-Regulated Health Plans,* Appendices Health Plan Name Fiscal Year End Report Type Statement Date Net Income /Loss (in millions) Total Revenue (in millions) Tangible Net Equity (in millions) Net Income (as Share of Revenue) 2010 California HealthCare Foundation 38 Medical Loss Ratio Admin. Cost Ratio Tangible Net Equity to Required Current Assets: Current Liabilities Plan Type enrollees (at Statement Date) Aetna Dec A 12/31/ % 88.1% 9.6% 311.5% 0.60 B 455,470 Alameda Alliance June A 6/30/ % 93.1% 9.1% 178.0% 1.37 C 103,756 Anthem Blue Cross Dec A 12/31/ % 83.3% 10.2% 433.8% 1.36 B 3,552,695 Arcadian Dec A 12/31/ % 78.2% 15.1% 316.4% 1.02 M 28,958 Arta Dec A 12/31/ % 87.4% 22.0% 108.4% 1.81 M 426 Blue Shield Dec A 12/31/ % 87.6% 11.3% 1,223.5% 0.48 B 2,601,504 CalOptima June A 6/30/ % 98.1% 4.3% 346.9% 0.97 C/B 378,977 CalOptima June YTD 12/31/ % 87.9% 8.2% 324.5% 0.96 C/B 400,504 Care1st Dec A 12/31/ % 89.1% 9.5% 305.0% 1.37 O 308,975 CareMore Dec A 12/31/ % 72.6% 11.1% 302.4% 1.31 M 33,860 CenCal June A 6/30/ % 99.1% 6.6% 134.2% 1.39 C 94,737 CenCal June YTD 12/31/ % 95.6% 7.6% 125.4% 1.45 C 98,785 Central California Alliance for Health Dec A 12/31/ % 91.6% 5.3% 452.3% 1.82 C 194,711 Central Health Plan Dec A 12/31/ % 89.7% 12.7% 127.3% 1.19 M 4,953 Chinese Community Health Plan Dec A 12/31/ % 88.5% 12.5% 705.0% 1.40 O 13,765 CIGNA Dec A 12/31/ % 97.4% 5.5% 159.6% 1.41 O 212,965 CIGNA Pacific (previously Great-West) Dec A 12/31/ % 71.7% 13.2% 552.4% 1.91 O 13,086 Citizens Choice Dec A 12/31/ % 86.0% 13.6% 105.4% 1.07 M 8,279 Community Health Group Dec A 12/31/ % 91.6% 6.5% 199.6% 1.57 C 115,685 Community Health Plan June A 6/30/ % 81.2% 10.5% 418.3% 1.74 C 180,003 Community Health Plan June YTD 12/31/ % 86.0% 10.4% 358.9% 1.67 C 186,721 Contra Costa Health Plan June A 6/30/ % 121.9% 5.6% 112.2% 1.71 O 82,298 Contra Costa Health Plan June YTD 12/31/ % 123.8% 6.6% 134.2% 1.18 O 81,847 *Most recent annual and selected year-to-date data for plans with fiscal year-end other than December. Key to Report Types: A: annual, A-est.: estimated annual (4th quarter YTD), Q: quarterly, YTD: year-to-date. Key to Plan Types: B (Big): 400,000 or more enrollees; M (Medicare): 70 percent or more enrollees in Medicare; C (Medi-Cal): 70 percent or more enrollees in Medi-Cal, Healthy Families, AIM; O (Other): all others. Plan types determined based on status at December 31, Status based on enrollment reports, disclosures, and footnotes filed in health plan financial reports to DMHC. Notes: Tangible net equity (TNE) is a measure of the physical worth of a company and excludes the value of intangible assets. Six new plans, not shown, had no enrollees at December 2009 (plan type in parentheses): Choice (M), Golden State (M), Humana (M), Premier (M), San Miguel Health Plan (M), and Talbert (O). Also not shown, Association Health Care Management, dba Family Care, a medical discount plan. L.A. Care and CalOptima qualify as both Medi-Cal oriented and big plans. On Lok qualifies as both a Medicare and a Medi-Cal oriented plan. Source: Department of Managed Health Care (DMHC), Health Plan Financial Summary Data.

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