Slideshow 10 states with the least competitive PPO markets

Published
  • September 24 2015, 4:37pm EDT
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Overview:

Health insurance industry insiders fear merger and acquisition activity is eroding market competition, a trend that could lead to increased premiums for employers and individuals. Recent research from the American Medical Association identified the top 10 states with the least competitive PPO markets based on market concentration levels as determined by the Herfindahl–Hirschman Index or HHI—a measure used by the U.S. Department of Justice and the Federal Trade Commission.

The HHI number can range from close to zero to 10,000. DOJ considers a market with a result of less than 1,000 to be a competitive marketplace; a result of 1,000-1,800 to be a moderately concentrated marketplace; and a result of 1,800 or greater to be a highly concentrated marketplace.

10) Hawaii

PPO HHI: 5,799

PPO with the largest market share: HMSA (Blue Cross Blue Shield HI) with 75%

PPO with the second largest market share: University Health Alliance with 11%

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9) Tennessee

PPO HHI: 5,812

PPO with the largest market share: Blue Cross Blue Shield TN with 75%

PPO with the second largest market share: Aetna with 12%

8) Nebraska

PPO HHI: 5,841

PPO with the largest market share: Blue Cross Blue Shield NE with 74%

PPO with the second largest market share: Aetna with 19%

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7) Delaware

PPO HHI: 6,095

PPO with the largest market share: Highmark with 75%

PPO with the second largest market share: Aetna with 21%

6) North Carolina

PPO HHI: 6,128

PPO with the largest market share: Blue Cross Blue Shield NC 77%

PPO with the second largest market share: Aetna with 14%

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5) Louisiana

PPO HHI: 6,189

PPO with the largest market share: Louisiana Health Services & Indemnity (BCBS) with 78%

PPO with the second largest market share: Aetna with 9%

4) Iowa

PPO HHI: 6,338

PPO with the largest market share: Wellmark (BCBS) with 78%

PPO with the second largest market share: Aetna with 13%

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3) Michigan

PPO HHI: 6,681

PPO with the largest market share: Blue Cross Blue Shield MI with 81%

PPO with the second largest market share: Aetna with 6%

2) South Carolina

PPO HHI: 6,775

PPO with the largest market share: Blue Cross Blue Shield SC with 82%

PPO with the second largest market share: Aetna with 9%

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1) Alabama

PPO HHI: 8,737

PPO with the largest market share: Blue Cross Blue Shield AL with 93%

PPO with the second largest market share: Aetna with 3%