Private Enrollment Surges in Texas Counties as Medicaid Eligibility Reviews Resume


June 20, 2024

Following the end of pandemic protections on March 31, 2023, many states throughout the country, including Texas, immediately resumed standard Medicaid eligibility reviews. These reviews, also referred to as redeterminations, caused Texas’ Private Enrollment – Individual and Commercial combined – to surge by nearly 1.81 million (M) enrollees through March 31, 2024, while Medicaid dropped by an inversely proportional 1.83M in the same time frame. In this brief, Mark Farrah Associates (MFA) analyzes private enrollment figures from County Health CoverageTM for the state of Texas and its top counties with a focus on health plan market position.

Competition and Market Share

As of March 31, 2023, approximately 16M people were enrolled in private enrollment plans in Texas. Out of nearly thirty carriers in the state offering private insurance, four companies provided coverage to at least 1M Texans, representing a combined total of 15M people, or about 84.3% of the state’s private enrollment market. Health Care Service Corporation (HCSC – the parent company of Blue Cross Blue Shield of Texas) held its top position in the market with 7.5M covered lives (41.9%). UnitedHealth maintained its second-place position with 20.6% of the market, covering an estimated 3.7M enrollees. CVS and Cigna round out the top four insurers, providing coverage for 2.4M (13.6%) and 1.4M (8.1%) members, respectively.



With 254 counties, Texas has more counties than any other state; however, most private enrollment is concentrated in the eastern portions of the state. The graph below shows the private enrollment metrics for the top counties in Texas, as of March 31, 2024 (1Q24). With over 2.9M enrollees, Harris County, where Houston is located, has the largest private enrollment market in the state. Dallas County and its neighbor, Tarrant County (Fort Worth), make up 18.7% of the state’s private enrollment, or about 3.3M people. Bexar (San Antonio), with 1.19M covered lives, and Travis (Austin), with 1.1M, are the only other counties in the state with more than a million Texans enrolled in private insurance.



  • Overall, private enrollment across the state of Texas grew by more than 1.8M year-over-year (YOY), or about 11.3%.
  • Private enrollment in Harris County grew by over 271 thousand (K) since 1Q23, a 10.1% YOY increase. With 41% of the county’s private insurance market, HCSC saw an estimated increase of over 87K enrollees, a 7.7% jump. UnitedHealth gained over 77K enrollees, equating to a 13.8% YOY increase.
  • Dallas County experienced a 7.8% YOY increase, gaining over 144K private enrollees. HCSC and UnitedHealth saw moderate gains in the county, with HCSC expanding by an estimated 51.3K (6.7%) and UnitedHealth seeing a growth of an estimated 41.2K (10.9%).
  • Tarrant County gained over 98K new enrollees (8%), Bexar County gained 108.5K (10.1%), and Travis County grew by 112.5K (11.4%).

Throughout the state, HCSC and UnitedHealth experienced significant YOY gains in private enrollment. HCSC private membership grew by over 679K, a 10% increase, while UnitedHealth gained nearly 475K, or about 14.8%. CVS and Cigna both reported significant gains in the Individual Texas marketplace in 2023 but took a more conservative approach in 2024, with higher premium increases compared to their peers. CVS dropped only 10.1K members (-0.4%) between 1Q23 and 1Q24. Cigna, however, saw a larger drop in enrollment, losing approximately 166K covered lives (-10.3%).

Mark Farrah Associates will continue to monitor enrollment across the state of Texas and the country, using County Health CoverageTM and integrating highly relevant sources to provide reasonable estimates of health insurance market share at these levels.

About County Health CoverageTM

County Health CoverageTM 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, Individual, Group, 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 CoverageTM.

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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