Continued Membership Increases for Second Quarter Health Insurance Business


September 25, 2023

Approximately 325 million people received medical coverage from U.S. health insurers as of June 30, 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 up from 315 million, or nearly 9.6 million additional members, from a year ago. In this brief, Mark Farrah Associates (MFA) assesses the latest year-over-year enrollment trends, comparing second quarter 2022 with second quarter 2023 segment membership.

Segment by Segment Enrollment Trends

Medicare Advantage (MA) membership continued to experience increases, as year-over-year trends have shown steady growth for over a decade. As of June 30, 2023, 2.1 million more seniors chose an MA plan from the previous year. Medicaid saw significant growth of over 4.6 million members, year-over-year. The Individual market for both on-and off-exchange business increased membership by over 1.7million and the Employer-Group ASO (Administrative Services Only) segment gained just over 2 million members, with total enrollment reaching approximately 128.6 million people as of 2Q23. In contrast to these enrollment increases, the Employer-Group risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, continued to experience a decline of over a million members.



  • Enrollment in Medicare Advantage (MA) continues to grow at a steady rate, however, only 48% of 65.5 million people eligible for Medicare are enrolled in an MA plan. Second quarter 2023 Medicare Advantage membership stood at approximately 31.3 million; a year-over-year increase of 2.1 million members, representing 7.3% growth, from June 30, 2022.
  • Over 93 million beneficiaries received healthcare through Managed Care Organizations (MCOs) and Fee-for-Service type Medicaid programs as of June 30, 2023. This is a 4.7 million, 5.3%, increase from June 2022, 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. Note: a portion of CHIP (Children’s Health Insurance Program) enrollment is reported in the Individual segment within statutory reporting. 
  • 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 2Q23. Total year-over-year individual membership for both on-and-off the exchange increased 10% from 17.7 million enrollees to over 19.5 million. This increase may be due to the overall growth in product availability and improved pricing position, as well as an extended Open Enrollment Period (OEP).


  • Employer-group, self-funded contracts continue to be 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. According to MFA’s recent estimates, Employer-group ASO (administrative services only for self-funded business) membership was approximately 128.6 million. This is another significant increase of over 2 million members from June of 2022. Membership for this segment encompassed 40% of total health enrollment for 2Q23.
  • Employer-groups continue to be the leading source of health coverage in the U.S, however, 2Q23 figures indicated Employer-group risk membership, including Federal Employees Health Benefit Plans (FEHBP) members, experienced yet another decrease between 2Q22 and 2Q23. Membership for the Employer-group risk segment was approximately 51.7 million as of June 30, 2023; a -2% year-over-year decline.


Market analysts throughout the industry rely on enrollment data and segment performance metrics to gain better insights into health plan market share and competitive positioning. MFA will continue to report on important plan performance and competitive shifts across all segments.

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, 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), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services) and various state agencies.

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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