Blue Cross Blue Shield of Michigan continues to dominate commercial enrollment outside of the exchange. Although COVID-19 did impact the payer mix in the state, no consequential shifts in market share are expected for the state's powerful Blue plan. But rivals Priority Health and Health Alliance Plan are jockeying for position by expanding their networks. The Michigan exchange had an average annualized rate hike for 2022. Ten insurers offer plans on the exchange, with two additions. With the onset of the COVID-19 pandemic, the managed Medicaid market witnessed growth in enrollment in the most recent cycle compared with the prior year. The MA market also has more plans with no annual drug deductible compared with prior years. In addition, many Medicare Advantage plans are participating in the Part D Senior Savings Model, which offers insulin at no more than a $35 monthly copay while some plans are covering end-stage renal disease (ESRD).