Five-Year Enrollment Trends Comparing Blues & Non-Blues Health Plans

May 28, 2026

Health insurance companies in 2025 provided fully insured coverage for approximately 183 million people, a decrease of over 1.1 million from 2021. Blue Cross Blue Shield (BCBS) association members, parent organizations, and their subsidiaries insured 37.2% of the total health insurance market, down slightly from last year. In this brief, Mark Farrah Associates (MFA) examined health insurance enrollment changes for the Individual, Group, Medicare and Medicaid segments for BCBS and non-BCBS companies between 2021 (4Q21) and 2025 (4Q25).

Overview

Fully insured health enrollment for non-BCBS reporting plans increased from129.0 million covered lives in 2021 to 135.4 million in 2022, but then fell to 132.3 million in 2023, and continued declining to approximately 128.7 million for 2025. For non-Blues plans, only the Individual and Medicare markets grew consistently during the five-year period.

BCBS plans reported total enrollment gains from 2021 to 2022, with enrollment increasing from 55.1 million, to over 56.7 million. However, enrollment decreased slightly in 2023 to 55.9 million and then continued to drop to 54.3 million in 2025. Combined BCBS and non-BCBS reporting plans showed a membership decline of roughly –0.6%, or approximately -1.1 million for the five-year period.

Enrollment By Segment

• Individual enrollment for BCBS companies increased 16.5% over the last 5 years, and non-BCBS companies reported a 78.2% increase during the same period. Over the 5-year period, BCBS companies gained over 1.2 million members in this segment from 2021 to 2025. Total 4Q25 Individual enrollment for BCBS plans was nearly 8.7 million and over 16.4 million for non-BCBS companies.
   
• Fully insured Group enrollment, which includes the Federal Employees Health Benefits Program (FEHBP), continued to experience decreases throughout the observed timeframe, with plans reporting losses of approximately -1.7 million (-6.5%) in BCBS enrollment and more than -3.5 million (-12.6%) in non-BCBS enrollment. Total 4Q25 Group enrollment for BCBS plans was nearly 24.5 million and just over 24 million for non-BCBS companies.
   
• During the 5-year period, Medicare Advantage (MA) enrollment increased by approximately 1.9 million for BCBS companies, representing a 41.7% increase, and non-BCBS MA enrollment increased by over 4.4 million, an 18.8% increase. Total 4Q25 MA enrollment for BCBS plans was approximately 6.4 million and 28.0 million for non-BCBS companies.
   
• Medicaid enrollment for BCBS reporting plans declined by -13.1%, with a decline of approximately -2.2 million members since 2021. For non-BCBS Medicaid plans, enrollment declined by -8.5 million (-12.4%) during the same period. Total 4Q25 Medicaid enrollment for BCBS plans was over 14.7 million and over 60.2 million for non-BCBS companies.

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 product pages and brochures available under the Our Products section of the website (www.markfarrah.com), or call 724-338-4100.

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