May 1, 2019
Mark Farrah Associates (MFA) assessed the latest year-over-year enrollment trends, comparing fourth quarter 2017 with fourth quarter 2018 segment membership based on data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care). As of December 31, 2018, almost 265.2 million people received medical coverage from U.S. health insurers. This number is down from 265.6 million, or approximately 428,000 members, from a year ago. Year-end enrollment trends indicate membership gains for Medicare Advantage (MA) and Employer Group administrative services only (ASO) business while the managed Medicaid market, Individual, and Employer Group Risk segments experienced year-over-year declines.
Segment by Segment Enrollment Trends
As of December 31, 2018, the Individual segment lost over 1.0 million members year-over-year (YOY) and the Employer Group Risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, experienced a decline of approximately 897,000 members. The Employer Group ASO segment persisted as the largest source of coverage in the industry, enrolling nearly 121.6 million people. Medicare Advantage experienced moderate growth in membership as over 736,000 more seniors chose an MA plan YOY. Managed Medicaid saw a slight decrease YOY, by more than 36,000 members. A more in-depth look at each segment follows.
As of December 31, 2018, almost 265.2 million people received medical coverage from U.S. health insurers, down approximately 428,000 members from a year ago. Year-end enrollment trends indicate membership declines for a majority of the health care segments. Health care will continue to be subjected to regulatory and political pressure as the upcoming presidential election approaches.
The Individual market continues to be the most volatile health care segment. Repealing the ACA remains a controversial topic that is gaining steam as 2020 swiftly approaches. While there has yet to be a popular front runner in terms of a conservative replacement plan, Medicare for All is a progressive replacement plan that aims for public sector health insurance. In addition, managed Medicaid has expanded under the ACA but recently work requirements have gained popularity. Managed Medicaid work requirement waivers have already been approved or are currently pending in 15 states. Currently, 37 states including the District of Columbia have chosen to expand their Medicaid programs. Although Montana is counted in the 37 expanded states, a bill is currently being discussed that would extend the current expansion cutoff date past June 30, 2019.
About the Data
The data used in this analysis brief was obtained from Mark Farrah Associates' Health Coverage Portal™ database. It is important to note that MFA estimated fourth quarter 2018 enrollment for a small number of health plans that are required to report quarterly enrollment but hadn’t yet filed. Employer group ASO figures may be estimated by Mark Farrah Associates using credible company and industry resources. Individual, Non-Group 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) and the CA DMHC (California Department of Managed Health Care). As always, 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™, 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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