What’s the Breakout of Small vs Large Health Insurance Plans?

Posted on October 31, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It never ceases to amaze me how our perceptions of how large something is can be skewed. It’s easy for us to see a really large company and assume that it must have the majority of the market share. This perception might be even more skewed because of companies like Google, Amazon, and Microsoft which really do have the majority of the market.

It’s a well-known idea in the tech startup world that the big winner will win the majority of the market, a second company will own most of the rest and then a long tail of others will have a small share and then eventually disappear. A great modern example of this is Uber followed by Lyft and then everyone else.

While this is an interesting way to look at a market when investing in tech companies, I’m surprised how often it doesn’t play out the same way in healthcare. The first time I saw this was in the lab market. Everyone knows that the 2 dominant players in the lab market are LabCorp and Quest. While they are both large companies, they still don’t have even close to a majority of the lab market. There are so many other independent labs and every hospital and health system has their own labs as well.

While looking at a recent report on the SMB Health Insurance Market by edifecs, I saw the same situation in the health insurance market. We all know about the massive health insurance companies that dominate the headlines. However, this report highlights the number of small and medium sized health plans out there. It was also interesting to note how these small plans are more concentrated in certain states.

If you don’t want to read the full report, this infographic summarizes a number of the stats and findings:

Is this result surprising to you? What does this mean for healthcare? Is there an opportunity for these small to medium size health plans to disrupt healthcare? Will we see more small plans chipping away at the large health plans?