Individual Health Insurance Marketplace Enrollment Reaches Record Levels
July 10, 2025
While the individual health insurance market has faced challenges over the years, enrollment for first quarter 2025 (1Q25) has reached record levels. According to financial statements filed by insurers, with estimates by Mark Farrah Associates (MFA), enrollment in individual medical plans, both on and off the exchange, totaled approximately 26.8 million, as of March 31, 2025. In this brief, MFA provides insights into recent enrollment and financial trends for the individual comprehensive health insurance segment.
Individual Health Insurance Market Trends
The individual market has seen several major regulatory reforms in the last fifteen years: the 2010 signing and 2014 final implementation of the Affordable Care Act (ACA), the 2020 public health emergency (PHE) due to the Covid-19 pandemic, and the 2023 lifting of Medicaid’s continuous enrollment provisions (Medicaid redeterminations). Enrollment increased in the early years of the ACA; however, after numerous court challenges, particularly around the individual mandate, enrollment began dropping in 2016. Enrollment remained stagnate in the years leading up to Covid-19 and the PHE. Since the end of 2020, individual enrollment has grown each year. Based on financial statements filed by insurers, with estimates by MFA, enrollment in individual medical plans, both on and off the exchange, totaled approximately 26.8 million, as of March 31, 2025, a gain of 2.3 million enrollees from March 31, 2024.
The surge of membership during the early years of the ACA may have looked good for insurers to the casual observer; however, the accompanying growth in medical spending - which, by the end of 2015, had greatly outpaced premiums growth - led to segment losses for most health plans. These poor financial results triggered an exodus of large national carriers from the individual market, causing premium hikes for those that remained.
Since 2017, the segment has been profitable for health plans. Since 2021, however, medical expenses have, once again, outpaced premium growth, leading to medical loss ratios (MLRs) above the ACA’s requirement for health insurers. The ACA calls for individual and small group market insurers to spend at least 80% of their premium revenues on clinical care and quality improvements.
Since year-end 2020, 19 insurance carriers have completely exited the individual marketplace. Many more have made strategic decisions to exit certain markets and expand in others – a decision based on many factors, primarily the ability to offer coverage at an affordable price. With nearly 1.5 million members, as of March 31, 2025, Aetna CVS Health has already announced that beginning on January 1, 2026, it will no longer offer individual and family plans.
It appears those strategic decisions and lessons learned during the early years helped stabilize the market through 2024, with premium growth staying slightly ahead of claims increases. Unfortunately, early indicators for 2025 suggest otherwise. As of 1Q25, plans are reporting an average aggregated traditional MLR of 80.4%, up from 78.9% in 1Q24. Premiums per member per month (PMPM) for 1Q25 are $566, up 4.2%, from $543 PMPM in 1Q24; claims for 1Q25 are $455 PMPM, up 6.2% from $428 PMPM in 1Q24.
Heavily rooted in the Medicaid segment, Centene gained over 1.2 million Individual members nationwide in 1Q25, possibly due to late Medicaid redeterminations. Oscar also reported significant enrollment growth for the period, gaining over 379,000 members during 1Q25. Both Health Care Service Corporation (HCSC) and UnitedHealthcare lost more than 150,000 Individual medical members each during the period.
Florida and Texas Market Developments
Notable recent market developments involve Florida and Texas, two of the largest individual markets in the country. Florida and Texas have the highest number of people enrolled in the individual coverage marketplace, as of March 31, 2025, with 4,888,383 and 3,974,257, respectively. Both states experienced significant changes in 1Q25.
- In Florida, Oscar and Centene both added nearly 300,000 new members during the period, while CVS lost roughly 320,000. In total, Florida added 295,000 new members during 1Q25 and over 430,000 year-over-year (YOY).
- In Texas, Centene added over 325,000 Individual enrollees, while UnitedHealth and HCSC lost approximately 161,500 and 114,300 net members, respectively. In total, Texas added 162,600 new members during 1Q25. Texas has added nearly 351,000 additional individual segment members YOY.
More Changes Ahead
The overall individual market increased by nearly 1.4 million members, or 5.5%, during 1Q25. This may be due in part to final Medicaid redeterminations, or people purchasing an individual plan on their own to gain the benefits of subsidized coverage before this option expires at the end of 2025. Enhanced ACA subsidies were first made available as part of the American Rescue Plan Act in 2021 and extended through the end of 2025 by the Inflation Reduction Act.
Recent increases in the individual market may reflect Millennials (born between 1981-1996) and Gen Z (born between 1997-2012) finally aging off their parents’ health insurance plans and purchasing their own coverage. The ACA requires that plans offered through the individual market, all employer plans, and plans that offer dependent child(ren) coverage make the coverage available until the child reaches age 26. Both married and unmarried children qualify for this coverage. The roughly 4 million 18-year-olds in 2014 [1] (born in 1996) would have turned 26 in 2022.
We may also be seeing a shift from employer coverage to the individual marketplace. Since 2020, U.S. businesses of all sizes have been able to reimburse their employees tax free for individual health insurance premiums and medical expenses through Individual Coverage Health Reimbursement Arrangements (ICHRAs). [2] Currently, there is no independent source for ICHRA enrollment. However, ICHRA’s are growing in popularity, according to the HRA Council, a trade association that includes health insurers, brokers, administrators, insurers, support organizations, and employers offering defined contribution health coverage. The 2025 HRA Council’s Report mentions there are roughly “13,000 U.S. businesses participating in the ICHRA and QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) ecosystem as of January 2025.” [2] Based on the HRA data this would equate to about 35,000 covered lives. Kaiser Family Foundation’s (KFF’s) 2024 Employer Survey noted that “Four percent of firms offering health benefits, and 7% of firms not offering health benefits, offered funds to one or more of their employees to purchase non-group coverage in 2024." [3]
With numerous changes proposed by the Centers for Medicare and Medicaid Services (CMS), including shortening the open and special enrollment periods, revisions to premium rate development methodologies, additional verifications of enrollee eligibility, cuts to enrollment support services, and subsidy decisions, all still unknown, the 2026 and beyond individual market will be challenging. MFA will continue to monitor the changes as they develop.
[1] According to the U.S. Census Bureau's "Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States: April 1, 2010, to July 1, 2014, there were 4,383,235 people who were 18 years old in the United States on July 1, 2014.”
[2] 2025 HRA Council Data Report - https://www.hracouncil.org/
[3] KFF Employer Health Benefits 2024 Annual Survey, page 58: https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2024-Annual-Survey.pdf
About U.S. Individual Health Coverage
For this analysis, individual enrollment includes consumers purchasing coverage for themselves and/or family members directly or through marketplace exchanges, not through a government program (such as Medicaid or Medicare) or from an employer or union. Individual enrollment is typically higher in the first quarter of the year, while medical expenses are typically lower, compared to year-end. Data in this analysis is based on statutory financial statements filed with state regulators, the NAIC (National Association of Insurance Commissioners), and the CA DMHC (California Department of Managed Health Care). It is important to note that Mark Farrah Associates (MFA) applies estimated enrollment figures for select carriers not required to report health enrollment on a quarterly basis and makes other adjustments based on market analysis. Furthermore, individual enrollment may include Medicaid programs, such as CHIP, as some states include subsidized lines in the individual segment. These factors may have resulted in nominal understatement or overstatement of enrollment.
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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