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Second Quarter Individual Health Insurance Market Trends


October 10, 2022

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 17.4 million as of June 30, 2022. In addition, the Centers for Medicare & Medicaid Services (CMS) reported in the Health Insurance Exchanges 2022 Open Enrollment Report that approximately 14.5 million consumers enrolled in Marketplace plans following the 2022 open enrollment period (OEP). This includes more than 10.3 million enrolled in the 36 states using the platform and 4.3 million enrolled in State-Based Marketplaces. Open enrollment for 2023 coverage starts 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

Health insurers reported total individual, non-group coverage for over 17.4 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 9.1% increase from the 15.9 million members in June 2021.  Leading insurers for this segment include Centene, Guidewell Mutual, Kaiser and Anthem, Inc.  Anthem and Kaiser experienced slight membership gains of 3% and .2%, respectively, while Guidewell saw a year-over-year enrollment increase of almost 7%, in individual business. Centene leads the nation with approximately 2.13 million Individual enrollees, however the company experienced a 1.6% year-over-year decrease in membership, as of June 30, 2022.



U.S. Individual Health Coverage

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 nearly 3 million members as of 2Q22.



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

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 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 83.5% of individual medical members were enrolled through Marketplace plans and 16.5% were enrolled in off-exchange plans.


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

Individual Market Financial Performance

As we reported on July 12, 2022 in our Business Strategy brief titled, “An Analysis of Profitability for the Individual and Small Group Health Insurance Markets in 2021”, profitability for health insurance companies dropped from nearly $8 billion in 2020 to a loss of ($1.7) billion for 2021 as the impact of covid related pent up demand began to rush through the health care system. Midway through 2022, plans are reporting increases in medical expenses that are outpacing gains in premiums, signaling further pressure on segment profitability for 2022. As always, 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™, 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.

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email address to the "Subscribe to MFA Briefs" section at the bottom of this page.

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