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Over 20 million people have enrolled in Affordable Care Act marketplace coverage since the start of the 2024 open enrollment period (OEP), reaching a record for the third consecutive year, according to CMS. Over 3.7 million people who have signed up for ACA plans are new enrollees this year.

More than 15.5 million people have enrolled through HealthCare.gov in the 32 states that use that platform, and another 4.8 million have enrolled across 18 states and the District of Columbia, which use their own marketplaces.

After adjusting enrollment figures to account for the fact that there is one fewer day included in the 2024 OEP data compared to last year’s report, an ACAsignups.net analysis showed that every state except Maine and the District of Columbia saw membership growth in 2024, ranging from 2.8% in Hawaii to 78.8% in West Virginia. A total of 10 states reported signup surges of more than 50%.

With the launch of a new website, Eli Lilly and Co. recently became the first pharmaceutical company to offer weight loss medications though a telehealth provider. The platform — LillyDirect — comes less than two months after Lilly’s weight loss drug Zepbound (tirzepatide) gained FDA approval and joined fellow glucagon-like peptide 1 (GLP-1) agonists from Novo Nordisk A/S, Wegovy (semaglutide) and Saxenda (liraglutide), in the burgeoning obesity drug market.

The weight loss medication market is currently dominated by Wegovy, a once-weekly injectable drug. The FDA initially approved semaglutide for Type 2 diabetes under the brand name Ozempic, but the agency expanded the indications to include weight management three years ago. Pharmacy formularies that cover more than half of commercial-plan enrollees categorize Wegovy as “preferred” or “preferred with utilization management restrictions,” — such as prior authorization and/or step therapy — according to MMIT Analytics. (MMIT is the parent company of AIS Health.)

At least 13.3 million people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage and another 24.9 million had their coverage renewed as of December 2023, according to the KFF Medicaid enrollment and unwinding tracker. Starting April 1, 2023, states were permitted to resume disenrolling people from Medicaid who were no longer eligible or failed to complete the redetermination process after a multiyear pause during the COVID-19 public health emergency.

The disenrollment rate so far has ranged from 62% in Texas to 10% in Maine. Overall, 71% of coverage losses were due to procedural reasons, when individuals didn’t complete their renewal process within a specific time frame or the state was unable to reach them. Over 90% of disenrolled people had their Medicaid coverage terminated for procedural reasons in New Mexico (95%), Utah (94%) and Nevada (91%).

Here’s how major health insurers’ stock performed in December 2023. UnitedHealth Group had the highest closing stock price among major commercial insurers as of December 29, 2023, at $526.47. Humana Inc. had the highest closing stock price among major Medicare insurers at $457.81.

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 approval of Eli Lilly and Co.’s Zepbound (tirzepatide) in November capped off a banner year for glucagon-like peptide 1 (GLP-1) agonists and their use in weight loss management. And the fuss over these much-hyped obesity drugs — originally approved to treat diabetes — is likely just beginning. While employer groups and commercial payers are agonizing over the potential cost of coverage, industry leaders and legislators are pushing for Medicare to cover GLP-1s as weight loss therapies. Medicaid programs, meanwhile, are also weighing their options.

GLP-1s are now “the No. 1 driver of non-specialty pharmacy trend,” Mercer’s lead pharmacy actuary Jon Lewis told AIS’s Health Plan Weekly in November. Zepbound joins fellow GLP-1s from Novo Nordisk A/S, Wegovy (semaglutide) and Saxenda (liraglutide), in the obesity market basket. (As diabetes therapies, Zepbound is marketed as Mounjaro, while Wegovy is known as Ozempic.) Despite crackdowns on off-label use of the drugs’ diabetes iterations and a seemingly endless wave of shortages, many in the industry are clamoring for increased consumer access to the drugs. The American Medical Association on Nov. 13 passed a resolution asking “health insurers to provide coverage of available FDA-approved weight-loss medications, including GLP-1 medications, to demonstrate a commitment to the health and well-being of our patients.”

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.

About 81% of people covered by 35 insurers and PBMs representing 117.8 million lives were enrolled in plans with copay accumulators as of September 2023, compared with 89% in 2022, according to data collected by AIS Health’s parent company, MMIT. About 71% of people were enrolled in plans with copay maximizers, down from 76% in 2022. However, on average, payers anticipated a 30% increase in the number of plan sponsors opting into such programs next year and a 14% increase in member enrollment in plans with copay accumulators and maximizers.

Copay accumulators prevent any monetary assistance that pharmaceutical companies offer commercially insured patients from counting toward their deductible or out-of-pocket maximum. Copay maximizers distribute the total amount of a manufacturer’s copay-offset funds over 12 months, making that amount the new monthly copayment on any given drug over the course of a year.

While lawmakers continue to point fingers at risk adjustment and coding practices in Medicare Advantage for increasing plan payments relative to traditional fee-for-service (FFS) Medicare, a new analysis published in JAMA puts a spotlight on the “intended payment differences” created by the quartile structure currently used to set MA payment benchmarks. The Medicare Payment Advisory Commission (MedPAC) has previously recommended replacing the four-tiered system and “rebalancing” MA pay. Researchers now estimate that this system has generated an additional $46.7 billion in additional payments to MA plans, which could fuel the desire of progressive lawmakers to overhaul how MA plans are paid.

Established by the Affordable Care Act, the quartile system pays plans more for serving counties with the lowest FFS spending by applying a statutorily determined percentage to the per capita FFS estimates of spending for each county. The adjustments range from 95% for the highest-spending counties to 115% for the lowest-spending counties. Benchmarks are calculated before plans submit their bids and are also adjusted based on a plan’s Star Rating.

Nearly 32 million people were enrolled in Medicare Advantage plans as of December 2023, up from about 29.5 million in December 2022, according to AIS’s Directory of Health Plans. And while the six national carriers led by UnitedHealthcare currently enroll 69.8% of the market, regional Blues affiliates, provider-sponsored payers and other locally focused insurers have largely continued to grow alongside them. Tech-enabled startup insurers, meanwhile, saw some of the most explosive gains — and losses — in 2023. See the year-end enrollment wrap-up in the graphics below.