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


May 30, 2024

Health insurance companies in 2023 provided fully insured coverage for approximately 188 million people, an increase of over 23.7 million from 2019. 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 health insurance enrollment changes for the Individual, Group, Medicare and Medicaid segments for BCBS and non-BCBS companies between 2019 (4Q19) and 2023 (4Q23).


Fully insured health enrollment for non-BCBS reporting plans increased from 114.8 million covered lives in 2019 to 122.6 million in 2020. Enrollment continued to grow to 129 million in 2021, and then again to over 135 million in 2022, but decreased to approximately 132 million in 2023.

Blue Cross Blue Shield plans reported total enrollment gains every year from 2019 to 2022, with enrollment increasing from 49 million, in 2019, to nearly 56.7 million, in 2022. However, enrollment decreased slightly between 2022 and 2023 from 56.7 million to 55.9 million. Combined BCBS and non-BCBS reporting plans showed a membership gain of roughly 14.49%, or 23.7 million from 2019 to 2023.

Enrollment By Segment



  • As indicated in the graph above, Individual enrollment for BCBS companies increased 21% over the last 5 years, and non-BCBS companies reported an 81% increase during the same period. Over the 5-year period, BCBS companies gained roughly 1.4 million members in this segment from 2019 to 2023.Total 4Q23 Individual enrollment for BCBS plans was over 8.1 million and over 13 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 -1.76 million (-6.47%) in BCBS enrollment and -4 million (-13%) in non-BCBS enrollment. Total 4Q23 Group enrollment for BCBS plans was just over 25.5 million and nearly 26 million for non-BCBS companies.
  • During the 5-year period, Medicare Advantage (MA) enrollment increased by approximately 1.5 million for BCBS companies, representing a nearly 41% increase, and non-BCBS MA enrollment increased by almost 7 million, a 35% increase. Total 4Q23 MA enrollment for BCBS plans was just over 5 million and over 26.5 million for non-BCBS companies.
  • Medicaid enrollment for BCBS reporting plans grew by 48%, with an increase of approximately 5.5 million members since 2019. Despite this segment experiencing a decline in membership between 2022 and 2023 of approximately -7 million for non-BCBS Medicaid plans due to the conclusion of the public health emergency (PHE), total Medicaid enrollment during the 5-year span grew by 8.2 million people, or 14%. Total 4Q23 Medicaid enrollment for BCBS plans was 17 million and 66.3 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 (, or call 724-338-4100.

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