Blue Cross Blue Shield (BCBS) Vs. Non-BCBS Companies Health Enrollment Trends


May 8, 2023

Health insurance companies in 2022 provided fully-insured coverage for over 190 million people, an increase of over 25.7 million from 2018. Blue Cross Blue Shield (BCBS) Association members, parent organizations, and their subsidiaries insured about 38% of the total health insurance market. In this brief, Mark Farrah Associates (MFA) examined the health insurance enrollment changes by segment between BCBS and non-BCBS companies during the five-year span between 2018 and 2022.

Fully-insured health enrollment for non-BCBS reporting plans decreased from 115.4 million covered lives in 2018 to 114.8 million in 2019. Enrollment rebounded to 122.6 million in 2020, and then notably increased to 129 million in 2021. For 2022, non-Blues plans reached 133.5 million enrollees for a net gain of over 18.1 million members since 2018.

Blue Cross Blue Shield plans reported total enrollment gains every year from 2018 through 2022, with enrollment increasing from 48.9 million, in 2018, to 56.6 million, in 2022. Combined BCBS and non-BCBS reporting plans showed a membership gain of roughly 15.68% from 2018 through 2022.



  • Individual enrollment for BCBS companies increased 7.22% over the last 5 years, and non-BCBS companies reported a 35% increase during the same period. Over the 5-year period, BCBS companies gained roughly 499,000 members in that segment in 2022.
  • Fully insured Group enrollment, which includes the Federal Employees Health Benefits Program (FEHBP), experienced consistent decreases throughout the observed timeframe, with plans reporting losses of approximately -1.2 million (-4.7%) in BCBS enrollment and -4 million (-13%) in non-BCBS enrollment.
  • Medicare Advantage (MA) enrollment increased by approximately 1.2 million for BCBS companies, representing a 32.75% increase, and non-BCBS MA enrollment increased by 5.9 million, a 33.2% increase.
  • Medicaid enrollment for BCBS reporting plans expanded by 63.3%, with an increase of approximately 7.2 million members since 2018. Despite initial declines in membership from 2018 to 2019, non-BCBS Medicaid plans grew by over 13.5 million, in 2022, for a total 22.95% increase between 2018 to 2022.

About the Data

The data used in this analysis was obtained from Mark Farrah Associates' Health Coverage Portal™ database. Findings reflect enrollment reported by carriers with business in the U.S. and U.S. territories. Data sources include the National Association of Insurance Commissioners (NAIC) and the California Department of Managed Health Care (CA DMHC) statutory filings.

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™, 5500 Employer Health PLUS, 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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