Notable Enrollment Increases for Year-End 2022 Health Insurance Business

April 27,2023

Despite social and economic consequences of the Covid-19 pandemic, which continued to resonate in 2022, the health insurance market persevered in most business segments. Approximately 318 million people received medical coverage from U.S. health insurers as of December 31, 2022, 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 from 309.2 million, or approximately 8.4 million additional members, from a year ago. In this brief, Mark Farrah Associates (MFA) assesses the latest year-over-year enrollment trends, comparing fourth quarter 2021 with fourth quarter 2022 segment membership.

Segment by Segment Enrollment Trends

Medicare Advantage (MA) membership continued to experience increases, as year-over-year trends have shown steady growth for over a decade. As of December 31, 2022, 562,000 more seniors chose an MA plan from the previous year. Managed Medicaid saw significant growth of over 5.4 million members, year-over-year. The Individual market for both on-and off-exchange business increased membership by just over a million and the Employer-Group ASO (Administrative Services Only) segment gained over 2.4 million members, with total enrollment reaching approximately 127.5 million people as of 4Q22. In contrast to these enrollment increases, the Employer-Group risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, experienced a decline of over a million members.

• Enrollment in Medicare Advantage (MA) continues to grow at a steady rate as more and more American seniors are entering retirement. However, only 48.7% of nearly 65.2 million people eligible for Medicare are enrolled in a MA plan, providing ample opportunity for health insurers with Managed Medicare business. Fourth quarter 2022 Medicare Advantage membership stood at approximately 28.6 million; a year-over-year increase of 562,000 members, representing 2% growth, from December 31, 2021.
   
• Approximately 91 million beneficiaries received healthcare through Managed Care Organizations (MCOs) and Fee-for-Service (FFS) type Medicaid programs as of December 31, 2022. This is a 5.47 million, or 6.4%, increase from December 2021, 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. Note: a portion of CHIP (Children’s Health Insurance Program) enrollment is reported in the Individual segment within statutory reporting. 
   
• For 2022, the Individual segment continued its steady upward trajectory with member participation growth, as well as an influx of more insurers entering the marketplace. With health insurance exchanges across the 33 marketplaces on the federal platform and the 18 state-based marketplaces, this segment saw another notable enrollment increase between December 31, 2021, and December 31, 2022. Total year-over-year individual membership for both on-and-off the exchange grew 6% from 16.6 million enrollees to over 17.6 million. This increase may be due to the overall growth in product availability and improved pricing position, as well as an extended Open Enrollment Period (OEP).

• Employer-group, self-funded contracts continue to remain popular amongst employers 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 exorbitant claims over many workers and their dependents. According to MFA’s recent estimates, Employer-group ASO (administrative services only for self-funded business) membership was approximately 127.5 million. This was a significant increase of 2.4 million members from December of 2021. Membership for this segment encompassed 40% of total health enrollment for 4Q22, as self-funded ASO plans continue to be a viable option for businesses.
   
• Employer-groups continue to be the leading source of health coverage in the U.S, however, year-end figures indicated Employer-group risk membership, including Federal Employees Health Benefit Plans (FEHBP) members, experienced another decrease between 4Q21 and 4Q22. Membership for the Employer-group risk segment was approximately 52.7 million as of December 31, 2022; a -1.9% year-over-year decline. 

Health insurers continue to bolster their reach for improved health care delivery by providing access to affordable healthcare, expanding choices and service options, and propelling competition and innovation. Market analysts throughout the industry rely on enrollment data and segment performance metrics to gain better insights into health plan market share and competitive positioning. As always, MFA will continue to report on important plan performance and competitive shifts across all segments.

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates' Health Coverage Portal™ database. It is important to note that MFA estimated fourth quarter 2022 enrollment for a small number of health plans that are required to report quarterly enrollment but had not yet filed. Employer group ASO figures may be estimated by Mark Farrah Associates using credible company and industry resources. Individual, Non-group 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.

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 (www.markfarrah.com), or call 724-338-4100.

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