2024 Health Insurance Enrollment Trends; a Segment Comparison

April 24, 2025

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’s) Health Coverage Portal™. In this brief, MFA assesses the latest year-over-year enrollment trends, comparing segment membership from 4^th Quarter 2024 with 4^th Quarter 2023.

Segment Overview

Approximately 319 million people received medical coverage from U.S. health insurers as of December 31, 2024, based on data filed in statutory financial reports from 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 number is up just over 271,000 members from December 31, 2023. Year-end enrollment trends indicate membership gains for Individual, Medicare Advantage (MA), and Employer Group – self-funded administrative services only (ASO) business – while the Medicaid market and Employer Group Risk segments experienced year-over-year declines.

As of 4Q24, market penetration continued to remain stable for MA business, as approximately 1.8 million more seniors chose an MA plan from the previous year. The Individual market for on-and-off exchange business increased membership by 4 million and the Employer-Group ASO segment gained just over 1.5 million members. In contrast to these enrollment increases, the Employer-Group Risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, declined by 1.5 million members and Medicaid lost nearly 5.6 million members, year-over-year.

Segment by Segment Enrollment Trends

• Across the 31 marketplaces on the federal platform and the 20 state-based marketplaces, Individual health enrollment continued to grow in 2024. Total year-end Individual membership for both on-and-off the exchanges increased 18.8% from 21.3 million members to almost 25.4 million. This increase is partly due to the continued influx of new Marketplace enrollees who lost Medicaid coverage as the pandemic-era provisions ended.
   
• Employer-groups continue to be a leading source of health coverage in the U.S; however, 4Q24 figures indicated Employer-group risk membership, including FEHBP members, experienced yet another decrease between 4Q23 and 4Q24. Membership for the Employer-group risk segment was approximately 49.9 million as of December 31, 2024; a -2.9% decline from 51.4 million the previous year.
   
• Employer-group, self-funded ASO contracts remain a viable option for businesses due to their cost-effectiveness versus risk-based plans. Self-funding is especially common among larger companies, as they can disperse the risk of steep claims over many workers and their dependents. Membership for this segment encompassed 41.4% of total health enrollment for 4Q24. According to MFA’s recent estimates, Employer-group ASO membership was approximately 132 million, an increase of 1.5 million members, or 1.2%, from 4Q23.
   
• Enrollment in Medicare Advantage continues to grow at a steady rate. Fourth quarter 2024 MA membership stood at approximately 33.4 million, a year-over-year increase of nearly 1.8 million members, representing 5.6% growth, from 4Q23.
   
• As of December 31, 2024, just over 78.2 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 5.6 million member, 6.7%, decline from the previous year. This decrease in enrollment is primarily due to the conclusion of the public health emergency (PHE), as many state health departments initiated “unwinding” plans of renewals and redeterminations, forcing enrollees to transition to Individual plans via the marketplace.
   

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates' (MFA’s) Health Coverage Portal™ database. Employer group ASO figures may be estimated by MFA 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, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For more information about these products, refer to the brochures that are available under the Our Products section of the website or call 724-338-4100.

Healthcare Business Strategy is a FREE 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 to the "Subscribe to MFA Briefs" section at the bottom of this page.