Health Insurance Enrollment Trends; a Third Quarter Segment Comparison

December 16, 2024

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 3rd quarter 2024 with 3rd quarter 2023 segment membership.

Approximately 319 million people received medical coverage from U.S. health insurers as of September 30, 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 down 2 million members from September 30, 2023. Year-end enrollment trends indicate membership gains for Medicare Advantage (MA), Employer Group self-funded administrative services only (ASO) business and Individual, while the Medicaid and Employer Group Risk segments continued to experience year-over-year declines.  

Segment Overview

As of 3Q24, market penetration continued for Medicare Advantage business, as over 1.3 million more seniors chose an MA plan from the previous year. The Individual market for on-and-off exchange business increased membership by nearly 4.8 million and the Employer-Group ASO (Administrative Services Only) segment gained approximately 2.3 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 experienced a loss of over 8.8 million members, year-over-year.

Segment by Segment Enrollment Trends

• Enrollment in Medicare Advantage continues to increase and ample opportunity for continued growth with 51% of the 67.5 million people eligible for Medicare are enrolled in an MA plan. Third quarter 2024 MA membership stood at approximately 33 million, a year-over-year increase of over 1.35 million members, representing 4.3% growth, from 3Q23.
   
• Total year-over-year Individual membership for both on-and-off the marketplace exchanges increased 23.3% from 20.6 million members to almost 25.4 million between 3Q23 and 3Q24. This notable increase is partly due to an influx of new Marketplace enrollees who lost Medicaid coverage as the pandemic-era provision continued to unwind. 
   
• Membership for Employer-group, self-funded ASO encompassed 41.4% of total health enrollment for 3Q24. According to MFA’s recent estimates, Employer-group ASO membership was approximately 131.8 million, an increase of over 2.3 million members, or 1.8%, from 3Q23. This segment is a viable option for businesses as they can be more cost effective than 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.
   
• As of September 30, 2024, nearly 78.6 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 an 8.8 million member, -10%, decline from the previous year. The decrease in enrollment is primarily due to the conclusion of the public health emergency (PHE) when many state health departments initiated “unwinding” plans of renewals and redetermination. 

• Employer-groups continue to be the leading source of health coverage in the U.S, however, 3Q24 figures indicated Employer-group risk membership, including Federal Employees Health Benefit Plans (FEHBP) members, experienced yet another decrease between 3Q23 and 3Q24. Membership for the Employer-group risk segment was approximately 50.1 million as of September 30, 2024; a -3% decline from 51.7 million the previous year.
   

Note: a portion of CHIP (Children’s Health Insurance Program) enrollment is reported in the Individual segment within statutory reporting. 

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, Medicare Business Online™, Medicare Benefits Analyzer™, 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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