Second Quarter Health Insurance Enrollment Trends: Market Segment Performance
September 29, 2026
Market analysts throughout the health insurance industry rely on enrollment data and segment performance metrics to gain better insights into health plan market share and competitive positioning. Many companies conduct their competitive assessments by using Mark Farrah Associates’ (MFA) Health Coverage Portal™. In this brief, MFA assesses the latest year-over-year enrollment trends, comparing 2nd quarter 2026 with 2nd quarter 2025 segment membership.
Segment Overview
As of June 30, 2026, approximately 312.5 million people received medical coverage from U.S. health insurers, according to statutory financial reports filed with the NAIC (National Association of Insurance Commissioners), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services), and various state agencies. This total was 2.8% lower than on June 30, 2025. Enrollment trends show year-over-year gains in Medicare Advantage (MA) and employer-group self-funded administrative services only (ASO) plans, while the Individual, Medicaid, and Employer Group Risk segments declined.
As of June 30, 2026, market penetration continued to increase for MA business for second quarter, as 700,000 more seniors chose an MA plan from the previous year. The Employer-Group ASO (Administrative Services Only) segment gained just over 1.1 million members. In contrast to these enrollment increases, the Individual market for on-and-off exchange business saw a decrease in membership by over 4.5 million and the Employer-Group risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, declined by 2 million members. Medicaid also experienced a loss of almost 4.1 million members, year-over-year.
Enrollment Trends: Segment by Segment
- Approximately 52% of the 70.2 million people eligible for Medicare are enrolled in a Medicare Advantage plan, which provides ample opportunities for insurers with MA business. Second quarter 2026 MA enrollment was approximately 35.1 million, an increase of 700,000 members, representing 2% growth, from 2Q25.
- Employer-group, self-funded ASO contracts are a viable option for businesses as they can be more cost effective than risk-based plans. Self-funding is specifically common among larger companies as they can disperse the risk of steep claims over many workers and their dependents. Membership for this segment encompassed 43.5% of total health enrollment for 2Q26. According to MFA’s estimates, Employer-group ASO membership was approximately 135.8 million, an increase of over 1.1 million members, or 0.8%, from 2Q25.
- Total year-over-year Individual membership for both on-and-off the marketplace exchanges decreased 17.2% from 26.5 million members to 22 million between 2Q25 and 2Q26. This is primarily due to enhanced federal subsidies that expired at the end of 2025.
- As of June 30, 2026, 73 million beneficiaries received healthcare through Managed Care Organizations (MCOs) and Fee-for-Service type Medicaid programs based on membership filed in statutory financial reports from the NAIC and the CA DMHC, as well as state reported Medicaid and CMS reported Medicaid enrollment reports. This is a 4.1-million-member decline, or -5.3%, from the previous year. The decrease in enrollment is due to several factors such as the conclusion of the public health emergency (PHE) when many state health departments initiated “unwinding” plans of renewals and redetermination, new federal policy changes like the 2025 budget reconciliation law, and tighter state eligibility rules including upcoming work requirements.
- Employer groups have been the leading source of health coverage in the U.S; however, 2Q26 enrollment figures continue to indicate Employer-group risk membership, including FEHBP members, experienced another decrease between 2Q25 and 2Q26. Membership for the Employer-group risk segment was approximately 46.7 million as of June 30, 2026; a 4.3% decline from the 48.8 million members the previous year.
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 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), the CA DMHC (California Department of Managed Health Care), CMS (Centers for Medicare and Medicaid Services) and various state agencies. 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™, 5500 Employer Health plus, ASO Employer Health plus, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For more information about these products, refer to the product pages and brochures available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.
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