PMPM claims calculator: what do claims cost per member per month?
Enter paid claims, the number of employees and members and the months in the period to calculate the per member per month figure. Built for HR and finance teams reading a claims report.
Calculate claims per member per month.
Use the average enrollment for the period. The result updates as you type.
Your estimate
A calculation from the figures you enter. Your carrier or administrator reports are the official source.
What does PMPM mean?
PMPM stands for per member per month. It divides total claims by the number of member months, which is the number of covered people multiplied by the number of months they were covered. Because it adjusts for group size and period length, it is a common way to compare claims across years, across plans and against a benchmark.
How should an employer use it?
Track PMPM by quarter or year to see the direction of cost. Split it into medical and pharmacy, and look at large claims separately, since a few can move the number. Compare it with the PMPM the carrier used to set rates or with the figure assumed for stop-loss. A rising PMPM is a prompt to look at the drivers.
Common questions
What is the difference between PMPM and PEPM?
PMPM divides by members, including dependents. PEPM divides by employees only. PEPM is higher because each employee brings dependents with them.
Should the figure include IBNR?
For a true picture, yes. Claims incurred but not yet reported can be sizable in recent months. Ask your carrier or actuary about them.
Do I use paid or incurred claims?
Either works if you use the same basis each time. Incurred claims give a fuller picture of the period.
Where can I get a claims report?
Your carrier or administrator can supply one, and we can help you read it.
Talk to us about your claims
Book a 30-minute call and we will look at your claims report, your trend and the options that fit. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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