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Health Insurance Membership Reaches Over 300M at 2Q21


October 4, 2021


Health insurers continue to persevere through the turbulence of the ever-changing healthcare landscape. Despite new challenges created by the COVID-19 pandemic, enrollment for the second quarter of 2021 increased in most health insurance segments.  In this brief, Mark Farrah Associates (MFA) assessed the latest year-over-year enrollment trends, comparing second quarter 2020 with second quarter 2021 segment membership. 

Based on data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care), nearly 301 million people received medical coverage from U.S. health insurers, as of June 30, 2021.  This number is up from 293.7 million, or approximately 7.2 million members, from a year ago.  Mid-year enrollment trends indicated membership gains for Individual, Medicare Advantage (MA), Managed Medicaid, while the Employer-Group risk segment and Employer-Group ASO (administrative services only for self-funded plans) business experienced a year-over-year decline. 



Individual, Non-Group

Although the individual market has had its share of challenges throughout the years, the segment has remained relatively stable throughout the pandemic. Some insurers even increased their geographic footprint for ACA-compliant plans.  In June 2021, health insurers reported total individual, non-group coverage for over 16.1 million people, this represents a 4.8% increase, or 734,000 members, from 15.4 million in June 2020.  This is the second year in a row with a year-over-year increase.  According to CMS, the Biden administration extended open enrollment for 2022 ACA coverage by another month and will now run from Nov. 1st through January 15th

Medicaid and CHIP

The Centers for Medicare & Medicaid Services (CMS) reported 82.3 million individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), as of April 2021.  Medicaid membership available through the NAIC and CA DMHC statutory sources accounts for approximately 76% of the total Medicaid membership.  In February 2021, MFA began reporting the remaining 24% related to state managed Medicaid programs Fee-for-service (FFS) and companies managing Medicaid care with membership that is not reported via the NAIC or CA DMHC.  

According to MFA’s Health Coverage Portal™ , which now represents a more complete picture of the Medicaid market, approximately 80.5 million beneficiaries received Medicaid in second quarter 2021.  This is an increase of 9%, or 6.6 million enrollees, from 2Q20 to 2Q21.  It is important to note that CHIP enrollment reporting, along with the timing of CMS data availability, account for the variance between CMS and MFA figures. 

Medicare Advantage

Medicare Advantage (MA) enrollment continues to experience increases as MA plans, with extra benefits and services at lower costs over original Medicare, remain an appealing option for seniors.  Although MA market penetration is strong, there is still ample opportunity for growth with only 42% of the 63 million people eligible for Medicare enrolled in MA plans.  As of June 30, 2021, Medicare Advantage experienced membership increases as nearly 2.4 million more seniors chose an MA plan from the same period a year ago.  According to plan-reported statutory reports, enrollment in MA plans grew from 24.6 million in June of 2020 to 27 million in June 2021. This is a sizable increase of 9.7% growth, due to the continuing number of seniors entering retirement each day. 




Employer-Group Risk

Although the employer-group risk segment continues to be the leading source of health coverage in the U.S., the latest figures show segment membership, including Federal Employees Health Benefit Plans (FEHBP) enrollment, experienced a decrease of 4% between 2Q20 and 2Q21. This is a year-over-year decline of over 2.2 million lives.  Mid-year 2021 Group-risk enrollment stood at 54 million as compared to 56 million in June of 2020.  While, many companies have shifted towards self-funded (ASO) insurance, in the years since the implementation of the ACA, to help control costs and improve the health and well-being of its employees, employee layoffs due to the economic downturn from the pandemic, may also be a cause this decline.

Employer-Group ASO

According to MFA’s recent estimates, Employer-Group ASO (administrative services only for self-funded business) membership slightly decreased by approximatley 267,000 members from June 2020 to June 2021.  MFA identified 123.2 million ASO covered lives, which encompassed 40% of total health enrollment for 2Q21.



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) and the CA DMHC (California Department of Managed Health Care).  As always, MFA will continue to report on important plan performance and competitive shifts across all segments.

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.

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email address to the "Subscribe to MFA Briefs" section at the bottom of this page. Mark Farrah Associates will continue to analyze and report on important health insurance segment performance and related topics. Stay tuned for future analysis briefs with valuable insights about the health care industry.

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