2023 Health Insurance Enrollment Trends; a Segment-by-Segment Comparison

April 25, 2024

Market analysts throughout the health insurance industry rely on enrollment data and segment performance metrics to gain better insights into health plan market share and competitive positioning. Many companies conduct their competitive assessments by using Mark Farrah Associates’ (MFA) Health Coverage Portal™. In this brief, MFA assesses the latest year-over-year enrollment trends, comparing 4^th quarter 2023 with 4^th quarter 2022 segment membership.

Segment Overview

Approximately 318 million people received medical coverage from U.S. health insurers as of December 31,2023, based on data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services) and various state agencies. This number is down 2.1 million members from December 31, 2022. Year-end enrollment trends indicate membership gains for Medicare Advantage (MA), Individual, and Employer Group, self-funded administrative services only (ASO) business, while the Medicaid market, and Employer Group Risk segments experienced year-over-year declines.  

As of 4Q23, market penetration continued to remain firm for Medicare Advantage business, as approximately 1.8 million more seniors chose an MA plan from the previous year. The Individual market for on-and-off exchange business increased membership by 3.5 million and the Employer-Group ASO (Administrative Services Only) segment gained just over 1.6 million members. In contrast to these enrollment increases, the Employer-Group risk segment, including Federal Employees Health Benefit Plans (FEHBP) business declined by 1.2 million members and Medicaid lost 7.8 million members, year-over-year.

Segment by Segment Enrollment Trends

• Enrollment in Medicare Advantage continues to grow at a steady rate; however, there is still opportunity for growth with 50.8% of the 66.7 million people eligible for Medicare enrolled in an MA plan. Fourth quarter 2023 MA membership stood at approximately 31.7 million, a year-over-year increase of over 1.8 million members, representing 6.3% growth, from 4Q22.
   
• With health insurance exchanges across the 33 marketplaces on the federal platform and the 18 state-based marketplaces, Individual health enrollment continued to grow in 2023. Total year-end Individual membership for both on-and-off the exchange increased 19.8% from 17.7 million members to over 21.1 million. This notable increase is partly due to an influx of new Marketplace enrollees who lost Medicaid coverage as the pandemic-era provision unwinds.
   
• Employer-group, self-funded ASO contracts are a viable option for businesses as they can be more cost effective than risk-based plans. Self-funding is specifically common among larger companies as they can disperse the risk of steep claims over many workers and their dependents. Membership for this segment encompassed nearly 41% of total health enrollment for 4Q23. According to MFA’s recent estimates, Employer-group ASO membership was approximately 129.8 million, an increase of 1.6 million members, or 1.3%, from 4Q22.
   
• As of December 31, 2023, just over 84 million beneficiaries received healthcare through Managed Care Organizations (MCOs) and Fee-for-Service type Medicaid programs based on membership filed in statutory financial reports from the NAIC and the CA DMHC, as well as state reported Medicaid and CMS reported Medicaid enrollment reports. This is a 7.8 million member, 8.5%, decline from the previous year. The decrease in enrollment is primarily due to the conclusion of the public health emergency (PHE) when many state health departments initiated “unwinding” plans of renewals and redetermination. 

Note: a portion of CHIP (Children’s Health Insurance Program) enrollment is reported in the Individual segment within statutory reporting. 

• Employer-groups continue to be the leading source of health coverage in the U.S, however, 4Q23 figures indicated Employer-group risk membership, including Federal Employees Health Benefit Plans (FEHBP) members, experienced yet another decrease between 4Q22 and 4Q23. Membership for the Employer-group risk segment was approximately 51.5 million as of December 31, 2023; a -2.4% decline from 52.7 million the previous year.
   

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates' Health Coverage Portal™ database. Employer group ASO figures may be estimated by Mark Farrah Associates using credible company and industry resources. Individual membership reported by some carriers may include CHIP (Children’s Health Insurance Program). These adjustments may have resulted in moderate understatement or overstatement of enrollment changes by segment. Findings reflect enrollment reported by carriers with business in the U.S. and U.S. territories. Data sources include NAIC (National Association of Insurance Commissioners), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services) and various state agencies. MFA will continue to report on important plan performance and competitive shifts across all segments.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, 5500 Employer Health ^plus, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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