Private Enrollment Market Share in New York Counties

June 19, 2023

Prior to the COVID-19 Pandemic, New York private health insurance enrollment stood at nearly 13.5 million covered lives (as of December 31, 2019). Private enrollment would drop to about 13 million by year-end 2020 and hold there, throughout 2021. By the end of 2022, private enrollment had climbed back up to almost 13.4 million enrolled. In this brief, Mark Farrah Associates (MFA) analyzes private enrollment figures from County Health Coverage^TM for the state of New York and its counties with a focus on health plan market position.

Competition and Market Share

As of December 31, 2022, approximately 13.4 million people were enrolled in private enrollment plans in New York. Out of sixteen providers in the state offering private insurance, five companies cover at least 1 million New Yorkers, representing a combined total of 11.7 million people, or about 87.4% of the state’s private enrollment market. UnitedHealth held its top position in the market with 4.6 million covered lives (34.6%). Elevance maintained its second-place position with 22.9% of the market, covering an estimated 3.1 million enrollees. Cigna, CVS, and Lifetime Healthcare round out the top five insurers, providing coverage for 1.5 million (11.4%), 1.3 million (10.2%), and 1.1 million (8.3%) members, respectively.

With more than 2.9 million enrollees, New York County has the largest private enrollment market in the state. The graph below shows the enrollment metrics for the top ten counties in New York, as of December 31, 2022 (4Q22). As expected, the counties surrounding New York City contain most of the membership, as nearly 73% of the state’s private enrollment resides within the New York City and Long Island areas (NY, SF, NA, KI, QU, WE, BR, RO, RI). In these counties, UnitedHealth and Elevance battle for market lead with 33.8% and 20.2% of private enrollment, respectively, while Cigna (8.5%), CVS (6.3%), and Emblem (3.2%) round out the top five insurers in these selected counties.

Refocusing perspective to outside the densely populated New York City, three other counties come into view: Erie (ER), Monroe (MN), and Albany (AL). With over 570,000 privately insured, Erie County is the largest of these three, but only just, as Monroe County represents nearly 565,000 covered lives and Albany almost 509,000. While the state’s largest insurers contribute some amount to the private enrollment in these counties, their market shares, and leaders, are considerably different than that of New York City.

In Erie County (ER), Highmark controls 40.6% of the county’s private enrollment market, representing nearly 232,000 enrollees. Independent Health Association offers private coverage to 151,000 (26.5%). Cigna, CVS, and Lifetime Healthcare round out the top five companies in Erie County.

With over 70% of Monroe County’s (MN) private enrollment, Lifetime Healthcare dominates the county’s market with almost 396,000 covered lives. Cigna, CVS, and MVP Health Care (MVP) comprise the remaining 30%.

Albany County (AL), home of the state capital, contains a private enrollment market of around 509,000 insured residents. Elevance provides private coverage for 183,000 (36%), similar in size to the next two largest insurers in the county combined, Capital District Physicians' Health Plan, Inc. (CDPHP) with 115,000 (22.6%) and Highmark with 69,000 (13.6%). Five companies make up the remaining 141,000, with notable callouts for Independent Health Association and MVP.

With the public health emergency (PHE) and the federal government’s continuous Medicaid coverage requirement concluded on March 31, 2023, the New York State Department of Health has initiated a year-long “unwinding” plan of renewals and redeterminations[i]. While it is currently unclear how these renewals will impact both private and Medicaid enrollments, evaluating market share in response to these changing laws and redeterminations will be an important measure of competitive positioning and health plan performance for insurers.

Mark Farrah Associates will continue to monitor enrollment across the state of New York and the country, using County Health Coverage^TM and integrating highly relevant sources to provide reliable estimates of health insurance market share at these levels.

About County Health Coverage^TM

County Health Coverage^TM provides reliable estimates of health insurance enrollment and market share at the state, county, and Metropolitan Statistical Area (MSA) levels. Product features include company market share by county, company, and state for the Private Risk, Private Administrative Services Only (ASO), Managed Medicaid, Medicare Advantage, and stand-alone Prescription Drug Plan (PDP) segments. Breakdowns by product type (HMO, PPO, etc.) are also presented, as well as population demographics and interactive, visual mapping tools. To learn more, visit the product page - County Health Coverage^TM.

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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