By the Numbers: National Health Insurance Market as of 3Q 2023

As of the third quarter of 2023, enrollment in both employer-based plans and Medicare Advantage plans had risen compared to the same period in 2022, according to AIS’s Directory of Health Plans. Managed Medicaid membership dropped year over year by approximately 2.1 million lives and plummeted by nearly 5 million lives from the fourth quarter of 2022, as states starting in April resumed their Medicaid eligibility redeterminations processes. Meanwhile, the Affordable Care Act marketplace scooped up many disenrolled Medicaid beneficiaries, adding more than 3.1 million new members year over year.

The top 10 MA insurers by membership enrolled a combined 25.6 million beneficiaries, or 79.5% of the national market. As of third-quarter 2023, UnitedHealthcare alone accounted for 28.7% of the national market, while Humana Inc. continued to hold the No. 2 slot at 18.2%. Centene Corp. was the only publicly traded insurer to see a double-digit membership loss at 16.1% between the third quarter of 2022 and the comparable 2023 quarter. The insurer has been struggling with its disappointing Star Ratings performance — 24 of its contracts fell below the 3-star mark for the 2023 plan year and four contracts received low performance warnings for the 2024 plan year.

Due to eligibility redeterminations, seven of the major Medicaid health plans saw membership losses as of the third quarter of 2023. Centene — the country’s largest Medicaid MCO — lost more than 731,000 members compared to the prior-year period, primarily due to disenrollments in Texas and Florida. CVS Health Corp.’s Aetna reported significant membership losses year over year, as more than 350,000 members left its Medicaid HMO plans. Medicaid enrollment is expected to continue to decrease over the next year, although it may rebound in some states due to Medicaid expansion or other state-specific factors. Most recently, North Carolina started implementing its Medicaid expansion on Dec. 1, 2023, and about 280,000 residents enrolled in the first weeks of the program.

Although there were no seismic changes in terms of insurer exits and expansions this year, the ACA marketplace reported impressive growth as disenrolled Medicaid members shifted to the exchange market. Centene, which is the country’s largest ACA exchange insurer, gained nearly 1.6 million new members due to its well-publicized strategy of reaching out to its recently disenrolled Medicaid beneficiaries. Aetna, which rejoined the marketplace in 2022, reported year-over-year membership growth of nearly 1,700% and ranked as the third largest ACA insurer. As CMS projected that more than 19 million individuals will enroll in marketplace coverage during the 2024 open enrollment period, insurers are likely to see even greater membership growth.

Enrollments in several Blue Cross and Blue Shield affiliates dropped slightly compared to the third quarter of last year. The Blues’ market leader, Elevance Health, Inc., still held almost 35.0% of the national health insurance market. In December, its $2.5 billion proposed acquisition of Blue Cross and Blue Shield of Louisiana after being paused in the midst of regulatory scrutiny. The deal could bring another 1 million new members to Elevance Health.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.