April 30, 2021
As U.S. health insurers continue to navigate the rough waters of the ever-changing healthcare landscape, most carriers remain resilient amid the adverse economic impact brought forth by the pandemic. The effects of COVID-19 have certainly been felt by consumers and businesses, but the full repercussions on the health insurance industry may not be completely realized for quite some time. Nonetheless, health insurers persevere with increasing efforts to improve 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. Mark Farrah Associates (MFA) assessed the latest year-over-year enrollment trends, comparing fourth quarter 2019 with fourth quarter 2020 segment membership. This assessment is 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.
As of December 31, 2020, approximately 296 million people received medical coverage from U.S. health insurers. This number is up from 288 million, or approximately 7.4 million additional members, from a year ago. Between 4Q19 and 4Q20, membership growth was significant in Medicare Advantage as this segment gained approximately 2 million more members, year-over-year. In addition, the individual health insurance market and Medicaid also experienced marked membership increases. The Employer-group ASO (administrative services only for self-funded plans) and Employer-group risk segments provide the largest sources of coverage in the industry, however, both segments continued to demonstrate year-over-year decreases in enrollment.
With some of the Coronavirus pandemic headwinds being felt already, the market outlook remains unpredictable. Many insurers are still reporting strong numbers; however, patients are now playing catch-up with their healthcare journey, thus providing uncertainty around the costs involved to pay for such claims. This, in turn, could potentially increase premiums and impact enrollment in the future. Only time will tell the outcome, as the health insurance industry continues to experience a period of unrest. Mark Farrah Associates will continue to monitor enrollment changes and competitive shifts across all healthcare segments, as the need for market share and financial performance data continues to be in high demand.
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 2020 enrollment for a small number of health plans that are required to report quarterly enrollment but hadn’t 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. 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.
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