By the Numbers: National Health Insurance Market as of 1Q 2023

Enrollment in both commercial health coverage and public health insurance slightly increased over the past six months, according to AIS’s Directory of Health Plans. Managed Medicaid membership continued to grow, from 74.0 million in 2022 to 76.5 million in 2023, while a record high 16.7 million people enrolled in Affordable Care Act marketplace coverage. Commercial (employer-based) health coverage grew by nearly 1 million lives, with several major national health plans reporting double-digit growth.

The top 10 Medicare Advantage insurers by membership enrolled a combined 24.5 million beneficiaries, or 77.7% of the national market. UnitedHealthcare alone accounted for 28.5% of the national market, while Humana Inc. took the No. 2 slot at 17.9%. Centene Corp. was the only publicly traded insurer to see a membership loss, partially due to its disappointing 2023 Star Ratings performance, as 24 contracts fell below the 3-star mark.

Over the past six months, membership in both managed Medicaid and ACA exchange plans has continued to grow. Centene, the country’s largest Medicaid MCO, saw 3.3% growth, whereas CVS Health Corp.’s Aetna lost more than 200,000 members compared to the third quarter of 2022. With the Medicaid eligibility redeterminations process now underway after a multi-year pause, an estimated 9.3 million Medicaid enrollees will transition to other forms of coverage, and an estimated 6.2 million will become uninsured, according to the Congressional Budget Office’s estimates. As of July 13, at least 2.1 million Medicaid beneficiaries across 30 states and the District of Columbia have been disenrolled since the resumption of eligibility redeterminations, according to KFF’s Medicaid Enrollment and Unwinding Tracker.

Aetna, Cigna Healthcare and UnitedHealthcare — which all expanded their ACA offerings in 2023 — each reported significant membership growth in the past six months. Aetna, which rejoined the ACA marketplaces in 2022, expanded its presence to four new states — California, Delaware, Illinois and New Jersey — in 2023, adding over 830,000 new members and making it the third largest ACA insurer.

Meanwhile, several Blue Cross and Blue Shield affiliates picked up market share over the past six months. As the Blues’ market leader, Elevance Health, Inc. held over 35.4% of the national health insurance market. Earlier this year, it signed a deal to acquire Blue Cross and Blue Shield of Louisiana, which could deliver the insurer 1 million new members. Blue Cross and Blue Shield of Illinois bounced back from losses in the past two years, netting over 300,000 members.

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