Enrollment Trends Among Large Insurers

The US has a very highly concentrated health insurance market.  Most local markets have only a few options, and enrollment is bunched in the Blue Cross plans, including Anthem, UnitedHealth Group, Aetna, Cigna and Kaiser.  Across all segments–employer and individual, Medicare and Medicaid–186.5 million people are enrolled in health plans in 2024, up 12.3 million from 2020.  The Blues plans accounted for 37.5% of all enrollees.  Relative enrollment varies by sector.   (MFA Associates)

In regard to individual coverage, the five-year growth rate for the BC plans was 36.6%, to 9.2 million people and the similar rate for non-BC plans was 106% to 16.2 million people.   When you compare this to Medicaid, you will see that the BC plans had small growth of only one million people or 6.7%, and non-BC plans actually lost 2.5 million members.  While the early part of the five-year period had strong Medicaid growth due to the epidemic expansion, 14 million people lost coverage after the end of that expansion and many went to the individual market, particularly the exchanges with their subsidies for many persons.

Medicare Advantage meanwhile has showed steady growth, with the BC plans adding 5.3 million persons for a 33% increase, while non-BC plans added 28.2 members, a 32% rate of growth.  In the group market, for fully insured business, BC plans grew at about 5% while non-BC plans rose 14%.  There was a decline in fully insured members over the period, but his was more than made up for by an increase in self-funded groups.  Employers continue to shift to self-funding due to its many advantages, such as exemption from most state laws and fewer mandated benefits, plus financial savings.