Call it a case of diminished expectations: UnitedHealthcare initially planned to participate in up to 25 state marketplaces. With each successive quarterly earnings call, however, the carrier's planned exchange profile seemed to fade. Now, you can count exchanges where UnitedHealth has applied with two hands. The carrier could still play in 10-12 exchanges, but it is being extremely picky.

Cigna and Aetna have been picky as well, but their foundations in small-group and individual policies are much smaller than UnitedHealth. In many states, UnitedHealth's leading market share hinges on success in the individual and small-group segments.

Arizona may illustrate the carrier's strategy. UnitedHealth is the top carrier in all market segments in that state, but chose to forego the exchange. With the state planning Medicaid expansion and every other major insurer planning to sell exchange policies, UnitedHealth may initially lose enrollment to its closest competitors (Blue Cross and Blue Shield of Arizona, Aetna and Cigna). However, there is zero chance UnitedHealth will lose the top perch, and nothing to stop it from selling exchange policies in 2015. If it follows that path, UnitedHealth could look astute for skipping the exchange in a year when the sick are more likely to enroll.

Skipping Colorado is more perplexing. UnitedHealth recently widened its market lead over Kaiser Permanente Colorado, Anthem and Cigna in the highly competitive market with a relatively health population. UnitedHealth will sell individual policies through a subsidiary, AllSavers Insurance Co., but that name might not resonate as well. If Colorado sees good exchange uptake, those competitors could potentially overtake UnitedHealth.

At first glance, several places UnitedHealth intends to sell exchange policies make little sense: Rhode Island, Kentucky, and Alabama. UnitedHealth runs close to Blue Cross and Blue Shield of Rhode Island, spicing up the small state's exchange. In Kentucky, home state carrier Humana and Anthem Blue Cross and Blue Shield of Kentucky far outstrip other market players enrollment. UnitedHealth runs a distant third, and keeping up with the two leaders requires a leap into the state- run exchange, where Anthem and Humana will also sell policies.

No state Blue plan has tighter control of market share than the Blue plan in Alabama. Even building a provider network is difficult for other carriers. If UnitedHealth ever wants to carve into the Alabama Blue's share, 2014 is the year. Kentucky and Alabama are not markets where waiting until 2015 will serve UnitedHealth's purposes.

The carrier seems bent on a two-year exchange strategy, fighting for share in tough markets in 2014, then shoring up strongholds and targeting healthier enrollees when penalties for non-enrollers rise in 2015. Other carriers betting on 2014 could make the latter goal much tougher for UnitedHealth.

Follow Bill Melville on Twitter @BillMelvilleHLI

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