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Individual Health Insurance Membership Continues to Grow

 

September 14, 2021

 

While the individual market has faced challenges over the past year amidst implications from the pandemic, overall, the segment continues to see enrollment growth.  According to financial statements filed by insurers and estimates by Mark Farrah Associates, enrollment in individual medical plans, both on and off the exchange, totaled approximately 15.9 million as of June 30, 2021.  In addition, the Centers for Medicare & Medicaid Services (CMS) reported in the Health Insurance Exchanges 2021 Open Enrollment Report that approximately 12 million consumers enrolled in Marketplace plans following the 2021 open enrollment period (OEP).  This includes more than 8.3 million enrolled in the 36 states using the HealthCare.gov platform and 3.8 million enrolled in State-Based Marketplaces.  Open enrollment for 2021 coverage starts on Nov. 1st and runs through Dec. 15th, although some states, including New York, New Jersey, California and Washington D.C. have extended their open enrollment periods. In this brief, Mark Farrah Associates (MFA) provides insights into individual health insurance enrollment trends and market developments with state-by-state membership comparisons.

Leading Competitor Exchange Participation

In June 2021, health insurers reported total individual, non-group coverage for over 15.9 million people, based on statutory financial statements filed with state regulators and the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care).  This represents a 4.9% increase from the 15.2 million members in June 2020.  Leading insurers for this segment include Centene, Guidewell Mutual, Kaiser and Anthem, Inc.  Anthem and Kaiser experienced marginal membership gains of 1.1% and .9%, respectively, while Centene and Guidewell saw year-over-year enrollment declines in their individual business. Centene leads the nation with approximately 2.2 million Individual enrollees, however the company experienced an 8% year-over-year decrease in membership.

 

Individual Segment - Members
 Company 2Q20 4Q20 2Q21
 Centene  2,343,042   2,248,426   2,155,792 
Guidewell Mutual (Florida BCBS)   1,269,954    1,173,709    1,267,180 
 Kaiser   1,138,215    1,083,121    1,148,145 
 Anthem  1,069,332  1,011,278  1,080,615 
Source: Health Coverage Portal™, Mark Farrah Associates, presenting data from NAIC, CA DMHC and CMS

 

U.S. Individual Health Coverage

As indicated in the heat map below, Florida, California, and Texas had the highest number of enrollees, with Florida covering nearly 2.6 million members as of 2Q21.  It is important to note that Mark Farrah Associates (MFA) applied enrollment figures for select carriers not required to report health enrollment on a quarterly basis and made other adjustments based on market analysis.  Furthermore, individual enrollment includes short term plan enrollees and may include Medicaid programs, such as CHIP, as some states include subsidized lines in the individual segment.  These factors may have resulted in moderate understatement or overstatement of enrollment.

 

Source: Health Coverage Portal™, Mark Farrah Associates, presenting data from NAIC, CA DMHC and CMS

 

The table below presents state-by-state breakdowns of the total individual market, separating on and off-exchange membership.  For this assessment, MFA applied the assumption that the difference between total individual enrollment reported by carriers and on-exchange, Marketplace enrollment reported in CMS’s Open Enrollment Period (OEP) public use files is a reasonable representation of off-exchange membership.  This analysis did not include state-by-state research to provide local market insights about exchange positioning nor did the analysts investigate off-exchange plan options.  Nonetheless, the state breakdowns provide a framework for understanding greater market opportunity. These figures indicate 75% of individual medical members were enrolled through Marketplace plans and 25% were enrolled in off-exchange plans.

 

 State  

June 2021 Total Individual Enrolled 

2021 On-Exchange Enrolled

Estimated Off-Exchange Enrolled

  AK

18,762

18,184

578

  AL

210,315

169,119

41,196

  AR

372,831

66,094

306,737

  AZ

200,957

154,504

46,453

  CA    

        2,306,168                1,625,546             680,622      

  CO

255,946

179,607

76,339

  CT

113,436

104,946

8,490

  DC

38,631

16,947

21,684

  DE

60

25,320

-25,260

  FL

2,577,100

2,120,350

456,750

  GA

680,455

517,113

163,342

  HI

38,548

22,903

15,645

  IA

153,106

59,228

93,878

  ID

103,584

68,832

34,752

  IL

396,746

291,215

105,531

  IN

142,931

136,593

6,338

  KS

149,030

88,627

60,403

  KY

110,885

77,821

33,064

  LA

140,984

83,159

57,825

  MA

375,869

294,097

81,772

  MD

277,103

166,038

111,065

  ME

63,187

59,738

3,449

  MI

354,167

267,070

87,097

MN 

166,042

112,804

53,238

  MO

231,376

215,311

16,065

  MS

184,153

110,966

73,187

  MT

52,329

44,711

7,618

  NC

596,207

535,803

60,404

  ND

44,604

22,709

21,895

  NE

86,810

88,688

-1,878

  NH

46,431

46,670

-239

  NJ

332,802

269,560

63,242

  NM

43,620

42,984

636

  NV

126,160

81,903

44,257

  NY

295,025

215,889

79,136

  OH

256,005

201,069

54,936

  OK

185,165

171,551

13,614

  OR

168,480

141,089

27,391

  PA

599,861

337,722

262,139

  RI

42,781

31,174

11,607

  SC

290,424

230,050

60,374

  SD

54,063

31,375

22,688

  TN

237,437

212,052

25,385

  TX

1,583,267

1,291,972

291,295

  UT

251,852

207,911

43,941

  VA

330,299

261,943

68,356

  VT

29,295

24,866

4,429

  WA

306,684

222,731

83,953

  WI

230,937

191,702

39,235

  WV

33,610

19,381

14,229

  WY             29,513                       26,728                  2,785     

 Total

15,916,033

12,004,365

3,911,668

Source: Health Coverage Portal™, Mark Farrah Associates, presenting data from NAIC, CA DMHC and CMS

 

Individual Market Financial Performance

As we reported on August 31, 2021 in our strategy brief titled “An Analysis of Profitability for the Individual and Small Group Health Insurance Markets in 2020 ”, profitability for health insurance companies reached its low point in 2015 with a nearly $6 billion underwriting loss.  Since then, through years of premium increases which outpaced growth in medical spending, companies have now posted four consecutive years of underwriting gains for the individual segment totaling over $22 billion.  For 2Q20 and 2Q21, plans in the individual segment reported a 1.6% increase overall in premiums per member per month (PMPM), from $36.3 billion to $38.5 billion in premiums earned.

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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