Learn More: Gross Margin Per Covered Life

Understanding Gross Margin Per Covered Life

Gross Margin Per Covered Life shows how much money an insurer retains per enrolled member after paying claims. It's calculated as total premiums minus total claims, divided by covered lives.

A higher number means the insurer is keeping more revenue per member after covering claims. A negative value means claims exceeded the premiums collected that year — a sign the plan ran at a loss for the insurer.

Tracked over time, this metric helps you see whether an insurer's margin is growing, shrinking, or swinging year to year, which can be a useful signal alongside loss ratio and premium trends when evaluating a plan.

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