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

June 2, 2025

Health insurance companies in 2024 provided fully insured coverage for approximately 186.5 million people, an increase of over 12.3 million from 2020. Blue Cross Blue Shield (BCBS) association members, parent organizations, and their subsidiaries insured about 37.5% of the total health insurance market. 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 2020 (4Q20) and 2024 (4Q24).

Overview

Fully insured health enrollment for non-BCBS reporting plans increased from 122.5 million covered lives in 2020 to 129.0 million in 2021. Enrollment continued to grow to 135.4 million in 2022, but then fell to 132.3 million in 2023, and continued declining to approximately 131.4 million for 2024.

Blue Cross Blue Shield plans reported total enrollment gains from 2020 to 2022, with enrollment increasing from 51.7 million, to over 56.7 million. However, enrollment decreased slightly between 2022 and 2023 from 56.7 million to 55.9 million and then again to 55.2 in 2024. Combined BCBS and non-BCBS reporting plans showed a membership gain of roughly 7%, or 12.3 million for the five year period from 2020 to 2024.

Enrollment By Segment

• Individual enrollment for BCBS companies increased 36.6% over the last 5 years, and non-BCBS companies reported a 106.1% increase during the same period. Over the 5-year period, BCBS companies gained almost 2.5 million members in this segment from 2020 to 2024. Total 4Q24 Individual enrollment for BCBS plans was over 9.2 million and over 16.2 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 -1.2 million (-4.6%) in BCBS enrollment and more than -3.8 million (-13.6%) in non-BCBS enrollment. Total 4Q24 Group enrollment for BCBS plans was just over 25.4 million and approximately 24.5 million for non-BCBS companies.
   
• During the 5-year period, Medicare Advantage (MA) enrollment increased by approximately 1.3 million for BCBS companies, representing a 32.8% increase, and non-BCBS MA enrollment increased by over 6.8 million, a 32.3% increase. Total 4Q24 MA enrollment for BCBS plans was just approximately 5.3 million and 28.2 million for non-BCBS companies.
   
• Medicaid enrollment for BCBS reporting plans grew by 6.7%, with an increase of approximately 959,000 members since 2020. For non-BCBS Medicaid plans, enrollment declined by -2.5 million (-3.9%) during the same period. This segment experienced a decline in membership between 2022 and 2024 of -14.2 million members due to the conclusion of the public health emergency (PHE). Total 4Q24 Medicaid enrollment for BCBS plans was over 15.2 million and nearly 62.5 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 informational videos and brochures available under the Our Products section of the website (www.markfarrah.com), or call 724-338-4100.

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