HMO Membership Reports

According to 211 CMR 43.05(2), each health maintenance organization (HMO) shall file quarterly reports with the Division 45 days after the close of each calendar quarter.

2025 HMO Membership Reports

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter
Membership Trend
Total Members
Group Members
Medicare Advantage Members
Other Medicare Members
Medicaid Members

Executive Summary

Total Health Maintenance Organization (“HMO”) membership in closed network plans decreased by 3,689 members from the end of the 4^th quarter of 2024 to the end of the 1^st quarter of 2025: a percentage change of -0.18%. During this time period, membership in group closed network plans decreased by 13,280 members; membership in Medicare Advantage closed network plans increased by 5,274 members; membership in other Medicare closed network plans decreased by 127 members; membership in Medicaid closed network plans decreased by 12,234 members; membership in individual closed network plans increased by 16,867 members; and membership in other closed network plans decreased by 189 members. Boston Medical Center Health Plan, Inc. had the largest share of insured members in closed network plans at the end of the 1^st quarter of 2025.

HMO membership in preferred network plans increased by 16,878 members from the end of the 4^th quarter of 2024 to the end of the 1^st quarter of 2025: a percentage change of 6.88%. During this period, membership in group preferred network plans decreased by 2,289 members; membership in Medicare Advantage preferred network plans increased by 17,640 members; membership in individual preferred network plans decreased by 194 members; and membership in other Medicare, Medicaid, and other preferred network plans remained at zero. Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. had the largest share of insured members in preferred network plans at the end of the 1^st quarter of 2025.

2024 HMO Membership Reports

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter
Membership Trend	Membership Trend	Membership Trend	Membership Trend
Total Members	Total Members	Total Members	Total Members
Group Members	Group Members	Group Members	Group Members
Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members
Other Medicare Members	Other Medicare Members	Other Medicare Members	Other Medicare Members
Medicaid Members	Medicaid Members	Medicaid Members	Medicaid Members
Individual Members	Individual Members	Individual Members	Individual Members
Other Members	Other Members	Other Members	Other Members

Executive Summary

Total Health Maintenance Organization (“HMO”) membership in closed network plans decreased by 2,656 members from the end of the 3^rd quarter of 2024 to the end of the 4^th quarter of 2024: a percentage change of -0.13%. During this time period, membership in group closed network plans decreased by 7,682 members; membership in Medicare Advantage closed network plans decreased by 2,759 members; membership in other Medicare closed network plans decreased by 35 members; membership in Medicaid closed network plans decreased by 2,415 members; membership in individual closed network plans increased by 10,425 members; and membership in other closed network plans decreased by 269 members. Boston Medical Center Health Plan, Inc. had the largest share of insured members in closed network plans at the end of the 4^th quarter of 2024.

HMO membership in preferred network plans increased by 884 members from the end of the 3^rd quarter of 2024 to the end of the 4^th quarter of 2024: a percentage change of 0.35%. During this period, membership in group preferred network plans decreased by 1,466 members; membership in Medicare Advantage preferred network plans increased by 2,004 members; membership in individual preferred network plans decreased by 194 members; and membership in other Medicare, Medicaid, and other preferred network plans remained at zero. Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. had the largest share of insured members in preferred network plans at the end of the 4^th quarter of 2024.

2023 HMO Membership Reports

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter
Membership Trend	Membership Trend	Membership Trend	Membership Trend
Total Members	Total Members	Total Members	Total Members
Group Members	Group Members	Group Members	Group Members
Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members
Other Medicare Members	Other Medicare Members	Other Medicare Members	Other Medicare Members
Medicaid Members	Medicaid Members	Medicaid Members	Medicaid Members
Individual Members	Individual Members	Individual Members	Individual Members
Other Members	Other Members	Other Members	Other Members

Executive Summary

Total Health Maintenance Organization (“HMO”) membership in closed network plans decreased by 59,464 members from the end of the 3^rd quarter of 2023 to the end of the 4^th quarter of 2023: a percentage change of 2.84%. During this time period, membership in group closed network plans decreased by 5,728 members; membership in Medicare Advantage closed network plans increased by 10,698 members; membership in other Medicare closed network plans decreased by 89 members; membership in Medicaid closed network plans decreased by 70,063 members; membership in individual closed network plans increased by 14,585 members; and membership in other closed network plans increased by 635 members. Boston Medical Center Health Plan, Inc. had the largest share of insured members in closed network plans at the end of the 4^th quarter of 2023.

HMO membership in preferred network plans increased by 293 members from the end of the 3^rd quarter of 2023 to the end of the 4^th quarter of 2023: a percentage change of 0.12%. During this period, membership in group preferred network plans increased by 1,310 members; membership in Medicare Advantage preferred network plans increased by 2,677 members; membership in individual preferred network plans decreased by 22 members; and membership in other Medicare, Medicaid, and other preferred network plans remained at zero. Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. had the largest share of insured members in preferred network plans at the end of the 4^th quarter of 2023.

2022 HMO Membership Reports

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter
Membership Trends	Membership Trends	Membership Trends	Membership Trends
Total Members	Total Members	Total Members	Total Members
Group Members	Group Members	Group Members	Group Members
Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members
Other Medicare Members	Other Medicare Members	Other Medicare Members	Other Medicare Members
Medicaid Members	Medicaid Members	Medicaid Members	Medicaid Members
Individual Members	Individual Members	Individual Members	Individual Members
Other Members	Other Members	Other Members	Other Members

Executive Summary

Total Health Maintenance Organization (“HMO”) membership in closed network plans increased by 741 members from the end of the 3^rd quarter of 2022 to the end of the 4^th   quarter of 2022: a percentage change of 0.04%. During this time period, membership in group closed network plans decreased by 11,336 members; membership in Medicare Advantage closed network plans increased by 1,647 members; membership in other Medicare closed network plans decreased by 897 members; membership in Medicaid closed network plans increased by 36,597 members; membership in individual closed network plans decreased by 7,362 members; and membership in other closed network plans increased by 1,075 members. Tufts Health Public Plans, Inc. had the largest shared of insured members in closed network plans at the end of the 4^th quarter of 2022.

HMO membership in preferred network plans decreased by 3,345 members from the end of the 3^rd quarter of 2022 to the end of the 4^th quarter of 2022: a percentage change of –1.01%. During this time period, membership in group preferred network plans decreased by 3,635 members; membership in Medicare Advantage preferred network plans increased by 1,623 members; membership in individual preferred network plans increased by 2,648 members; and membership in other Medicare, Medicaid, and other preferred network plans remained at zero. Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. had the largest share of insured members in preferred network plans at the end of the 4th quarter of 2022.

2021 HMO Membership Reports

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter
Membership Trends	Membership Trends	Membership Trends	Membership Trends
Total Members	Total Members	Total Members	Total Members
Group Members	Group Members	Group Members	Group Members
Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members
Other Medicare Members	Other Medicare Members	Other Medicare Members	Other Medicare Members
Medicaid Members	Medicaid Members	Medicaid Members	Medicaid Members
Individual Members	Individual Members	Individual Members	Individual Members
Other Members	Other Members	Other Members	Other Members

Executive Summary 

Total Health Maintenance Organization (“HMO”) membership in closed network plans decreased by 6,388 members from the ends of the 3^rd quarter of 2021 to end the end of the 4^th quarter of 2021: a percentage change of -0.33%. During this time period, membership in group closed network plans decreased by 9,502 members; membership in Medicare Advantage closed network plans decreased by 12 members; membership in other Medicare closed network plans decreased by 41 members; membership in Medicaid closed network plans increased by 14,383 members; membership in individual closed network plans decreased by 11,216 members; and membership in other closed network plans remained at zero. Tufts Health Public Plans, Inc. had the largest shared of insured members in closed network plans at the end of the 4^th quarter of 2021.

HMO membership in preferred network plans increased by 2,169 members from the end of the 3^rd quarter of 2021 to the end of the 4^th quarter of 2021: a percentage change of 0.97%. During this time period, membership in group preferred network plans increased by 1,603 members; membership in Medicare Advantage preferred network plans increased by 610 members; membership in individual closed network plans decreased by 44 members; and membership in other Medicare, Medicaid, and other preferred network plans remained at zero. Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. had the largest share of insured members in preferred network plans at the end of the 4^th quarter of 2021.

2020 HMO Membership Reports

By County

1st Quarter	2nd Quarter	3rd Quarter	4th Quarter
Membership Trends	Membership Trends	Membership Trends	Membership Trends
Total Members	Total Members	Total Members	Total Members
Group Members	Group Members	Group Members	Group Members
Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members	Medicare Advantage Members
Other Medicare Members	Other Medicare Members	Other Medicare Members	Other Medicare Members
Medicaid Members	Medicaid Members	Medicaid Members	Medicaid Members
Individual Members	Individual Members	Individual Members	Individual Members
Other Members	Other Members	Other Members	Other Members

Executive Summary

Total Health Maintenance Organization (“HMO”) membership in closed network plans increased by 19,192 members from the end of the 2^rd quarter of 2020 to the end of the 3^th quarter of 2020; a percentage change of 0.98%. During this time period, membership in group closed network plans decreased by 20,692 members; membership in Medicare Advantage closed network plans increased by 1,108 members; membership in other Medicare closed network plans increased by 7 members; membership in closed network Medicaid plans increased by 36,429 members; membership in closed network individual plans increased by 2,340 members; and membership in other closed network plans remained at zero. Tufts Health Public Plans, Inc. had the largest share of insured members in closed network plans at the end of the 3^rd quarter of 2020.

Introduction

An HMO is an entity licensed by the Division of Insurance ("Division") under the provisions of M.G.L. c. 176G that provides or arranges for the provision of health services to voluntarily enrolled members in exchange primarily for a prepaid per capita or aggregate fixed sum that demonstrates to the satisfaction of the Commissioner proof of its capability to provide its members protection against loss of prepaid fees or unavailability of covered health services resulting from its insolvency or bankruptcy or from other financial impairment of its obligations to its members. The HMO contracts with specific groups of providers to furnish the specified health care services covered by the HMO's Evidence of Coverage.

According to the provisions of 211 CMR 43.05(2), HMOs must file quarterly reports with the Division within 45 days of the close of each calendar quarter. The Division has requested that these reports only include statistics of membership for which the risk of financial loss has been transferred to the HMO; that is, it does not include so-called "self-insured" business. This report summarizes the membership information included in each carrier's report.

Membership is identified by the following categories:

1. Group - members enrolled with the HMO through an entity (e.g., employer, association or trust) paying premiums to the HMO to cover eligible members of the entity. This category includes the following types of group members:

GIC - employees of the Massachusetts state government enrolled through the Group Insurance Commission.

Federal - employees of the federal government.

COBRA - members who receive their health coverage from the HMO pursuant to continuation of coverage protections guaranteed by the Consolidated Omnibus Budget Reconciliation Act of 1985 and members who receive their health coverage pursuant to M.G.L. c. 176J, § 9 for groups with between 2 - 19 eligible employees.

Merged Market - members enrolled in those merged small group/individual products (pursuant to Chapter 58 of the Acts of 2006) who belong to an entity (e.g., employer, association, or trust) paying premiums to the HMO to cover eligible members of the entity.

2. Medicare Advantage - members enrolled in a MedicareAdvantage contract with the Centers for Medicare and Medicaid Services ("CMS"). [Formerly known as Medicare+Choice, renamed by the Medicare Prescription Drug Improvement and Modernization Act of 2003.]

3. Other Medicare - members enrolled in other Medicare plans, including, for example, so-called "Medicare Wrap-Around" policies.

4. Medicaid - members with HMO health coverage in which reimbursement is provided pursuant to Title XIX of the Federal Social Security Act.

5. Individual - members who do not belong to a group and who directly contract with the HMO for coverage. Statistic includes those merged small group/individual product (pursuant to Chapter 58 of the Acts of 2006) members who enroll as individuals, and do not belong to a group. Statistic also includes closed guaranteed issue health plan members, and closed nongroup health plan members. Statistic may include a subscriber's formerly dependent divorced spouse following subscriber's remarriage. Statistic does not include (a) individual conversion policy members (included in the Other category); (b) COBRA members (included in the Group category); or (c) self-employed small group members (included in the Group category).

6. Other - members whose group coverage and COBRA coverage have expired and who have converted to an individual (conversion) policy.

The membership statistics reflect information filed by the organization ONLY and are based upon the Massachusetts Division of Insurance's "Guidelines for Reporting Membership and Utilization Statistics - Version 6.1" that instructs HMOs to exclude members for whom the HMO did not bear any financial risk. Membership is reported only for members residing in Massachusetts, based on the county of residence, according to the zip code of the member's primary residence listed on the member record (or subscriber record, if dependent's address is not available); if the member's primary residence was outside Massachusetts, it is not included on the attached membership report. For the purpose of this report, membership includes all subscribers or covered dependents of a subscriber (including divorced spouses and newborns covered under the carrier's HMO plan) for whom the carrier has accepted the risk of financing necessary health services.

Starting with the first quarter of 2017, carriers are no longer submitting data for this report directly to the Division.  Instead, beginning with the first quarter 2017, data shown in this report was produced by the Center for Health Information and Analysis using data submissions by the HMOs to the All-Payer Claims Database.  As a result, comparing membership for certain quarters may not be appropriate, as the data is taken from separate sources.