December 18, 2023
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 20.4 million as of September 30, 2023. This is the largest number of participants this segment has seen as redeterminations have removed millions from Medicaid roles, causing some individuals to take advantage of the increased Marketplace subsidies, and to seek health insurance coverage from the Individual segment. Open enrollment for 2024 coverage started on Nov. 1st and runs through Jan. 15th. In this brief, Mark Farrah Associates (MFA) provides insights into individual health insurance enrollment trends and market developments with state-by-state membership comparisons.
Competitor Exchange Participation
For 3Q23, health insurers reported total individual, non-group coverage for 20,371,963 million people, based on statutory financial statements filed with the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care and aggregated from MFA’s Health Coverage Portal™. This represents a 15.8% increase from the 17.6 million members reported in 3Q22. All the leading insurers for this segment Centene, Guidewell Mutual, Elevance Health and CVS experienced significant enrollment gains between 3Q22 and 3Q23. Guidewell and Elevance increased membership by 10.4% and 17.3%, respectively. CVS saw a year-over-year enrollment increase of 648.5%, in its Individual business as the company added counties in existing states and entered 4 new states for ACA Marketplace in 2022: California, Delaware, Illinois, and New Jersey. Centene leads the nation with over 3.8 million enrollees, increasing its Individual members 75% as of September 30, 2023.
Individual Health Coverage in the U.S.
As indicated in the heat map below, Florida, California, and Texas continue to have the highest number of enrollees in the country, with Florida covering 3.6 million members as of 3Q23.
Note: 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.
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 into 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 80% of individual medical members were enrolled through on-exchange Marketplace plans and 20% were enrolled in off-exchange plans.
A Brief Financial Performance Overview
As we reported in August 2023 in our business strategy brief titled “An Analysis of Profitability for the Individual and Small Group Health Insurance Markets in 2022 ”, while segment membership is trending up, segment profitability for health insurance companies is marginal, at $0.5 billion underwriting gain or 0.5% of adjusted premium revenues for 2022. For 3Q23, plans in the individual segment reported a 1.8% year-over-year increase overall in premiums per member per month (PMPM), from $69.1 billion to $79.5 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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