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Finding the Profit Zone: Business Designs for the Individual Health Insurance Market

The individual market for health insurance is about to grow dramatically. But health plans need to address a critical strategic question: Will this burgeoning new space represent a “no-profit zone” of empty revenue, or will it support next-generation products and an operating environment where insurers can make money?

In Finding The Profit Zone: Business Designs for the Individual Health Insurance Market, we take the latter view. Our research identifies the key considerations when deciding if and how to play in a given market. We focus on where profits can be found and potential danger zones (see Red Zone in the below table) both on and off the exchanges, and offer insight into the types of business designs we think will succeed.

Capturing the profits in a post-reform market requires a targeted and thoughtful approach.

Finding the Profit Zone: Business Designs for the Individual Health Insurance Market

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