By the Numbers: National Health Insurance Market in December 2022

Three years into the COVID-19 pandemic, enrollment in both commercial health coverage and public health insurance continued its growth. Managed Medicaid membership jumped from 61.4 million in December 2020 to 74.0 million in 2022, while Medicare Advantage (MA) enrollment reached 29.9 million this year, compared with 25.2 million in 2020, according to AIS’s Directory of Health Plans. Commercial health coverage gained 300,000 enrollees over the past year, yet several major health plans reported slight decreases in commercial enrollment, including Centene Corp. and CVS Health Corp.’s Aetna.

The top 10 MA insurers enrolled a combined 23.1 million beneficiaries, or 77.2% of the national market. Centene reported MA enrollment growth of more than 20%, partially due to its double-digit enrollment gain through the 2022 Medicare Annual Election Period plus Open Enrollment Period. Guidewell Mutual Holding Corp., the parent company of Florida Blue, reported the biggest boost at 75% year-over-year, following its February acquisition of Triple-S Management Corp., one of the largest MA insurers in Puerto Rico.

In 2022, the number of beneficiaries enrolling in stand-alone Prescription Drug Plans kept dropping, making it the first year that Medicare Advantage Prescription Drug (MA-PD) plans’ enrollment surpassed PDP enrollment, according to a Kaiser Family Foundation analysis. Centene, which acquired WellCare Health Plans, Inc. in 2020, was the only major PDP insurer with a membership gain in 2022.

The temporarily expanded premium subsidies in the individual market kept driving membership growth in managed Medicaid and exchange plans in 2022. Among the top 10 Medicaid insurers, Molina Healthcare saw the biggest growth, as it acquired My Choice Wisconsin in July and expanded its footprint in the state. However, insurers and state Medicaid agencies are facing a host of challenges, as Medicaid eligibility redeterminations are set to resume in April 2023, causing an estimated 18 million Medicaid enrollees to lose their coverage over the following 14 months, an Urban Institute analysis projected.

As of December 2022, over 14.6 million Americans had signed up for Affordable Care Act plans. Bright Health Group saw significant year-over-year membership growth in 2022, yet in 2023 it will pull out of all 15 states in which it sold ACA exchange plans.

Several Blue Cross and Blue Shield affiliates picked up market share over the past year. As the Blues’ market leader, Anthem, Inc. (now Elevance Health) held almost 35% of the national health insurance market. Blue Cross and Blue Shield of Illinois ranked second, yet it has lost over 300,000 members in the past two years.

NOTES: Per AIS’s research methodology, Medicare Advantage membership includes lives enrolled in Medicare Advantage plans, Dual-Eligible Special Needs Plans and CMS’s Financial Alignment Initiative demonstration plans for Medicare-Medicaid dual eligibles. Medicaid MCO data includes Medicaid HMO and CHIP enrollment. Kaiser Permanente’s seven regional managed care organizations are represented as separate entities in DHP; Centene and its WellCare subsidiary are represented as separate entities in DHP; GuideWell Mutual Holding Corp.’s subsidiaries, Florida Blue, Triple-S Management Corp., and Capital Health Plan, Inc. maintain separate listings in DHP.

SOURCE: AIS’s Directory of Health Plans, as of December 2022, 2021 and 2020.

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

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