Market share health insurance plans us

This represents an outsize year for insurer and enrollment growth. More than 3.6 million new consumers entering the market are choosing among an average of 88 plans.

The year 2023 marks the tenth year of operation for the US health insurance exchanges since they launched as part of the Affordable Care Act in 2014. The individual market has remained fluid during this time, with insurer participation, pricing, and plans changing from year to year.

Findings in this document are based on publicly available information. Rates for 2014 through 2023 come from the McKinsey Exchange Offering Database, which includes county- and plan-level information from publicly available rate filings and healthcare.gov. The consumer population is defined as the population that has enrolled in any type of individual coverage, including on-exchange and off-exchange plans. Full-year enrollment for 2022 is projected.

The data for prior years in this article is slightly different from the data in last year’s article 1 Stephanie Carlton, Mike Lee, and Arjun Prakash, “Insights into the 2022 individual health insurance market,” McKinsey, August 3, 2022. because we undertook some additional preprocessing steps (for example, cleaning, quality assessment, validation, and adding missing data). We also refreshed the data to consistently account for M&A activity over the years.

Due to data availability limitations, the analysis excludes the following counties in New York:

• 2020: Herkimer, Montgomery, Orleans, Saratoga, Schuyler, Tompkins, Washington, Wayne, and Wyoming (combined estimated enrollment 12,969)
• 2021: Chemung, Erie, Montgomery, Orleans, Saratoga, Washington, Wayne, and Wyoming (combined estimated enrollment 20,427)

Pricing. Pricing analyses in this document are based on on-exchange plans only; this report does not include off-exchange pricing data. For consistency, premiums were obtained for a 27-year-old nonsmoking individual without family or partner coverage. To understand the premium changes that consumers will see (before the impact of subsidies), we calculated the weighted average rate change in premiums from 2022 to 2023 for the lowest-price silver plan in each rating area and county combination. First, we established a distribution of individuals using individual market plans in each county based on Federal Information Processing Standards (FIPS) codes. Next, we combined this population distribution with data about premiums for lowest-price silver plans in 2022 and 2023. Finally, we used the 2022 and 2023 premiums to calculate weighted average rate changes for all 50 states and the District of Columbia individually and collectively.

Insurer participation. To calculate insurer participation, including the consumer view of insurer participation, we analyzed the number of unique insurer parent companies that are offering plans on exchanges.

Insurer categories. Insurer categories are defined as follows:

• Blues: insurers that are members of the Blue Cross Blue Shield Association
• Consumer operated and oriented plan (CO-OP): a recipient of federal CO-OP grant funding
• Medicaid: an insurer that also operates as a managed care organization (MCO) and whose main line of business outside of individual coverage is in Medicaid
• National: a multistate, non-Blue insurer with a nationwide commercial footprint (for example, Aetna CVS Health, United HealthCare, Cigna)
• Provider: an insurer that also operates as a provider or health system
• Regional/local: a nonprovider, non-Blue insurer with a presence typically in a single state, but that may include a collection of states with regional focus
• Insurtech: a venture capital–backed insurer, typically with an innovative, tech-first value proposition (for example, Bright Health, Friday Health Plan, Oscar Health)

Plan types. Plan types reported here were taken directly from insurer rate filings and summary of benefits and coverage documents. Independent assessment of plan types was not part of the analysis presented in this document. Plan types are defined as follows:

• HMO: A health maintenance organization is a plan typically centered on a primary-care physician who acts as a gatekeeper to other services and referrals. It usually provides no coverage for out-of-network services, except in emergency or urgent-care situations.
• EPO: An exclusive provider organization is a plan similar to an HMO. It usually provides no coverage for any services delivered by out-of-network providers or facilities except in emergency or urgent-care situations; it generally does not require members to use a primary care physician for in-network referrals.
• PPO: A preferred provider organization is a plan that typically allows members to see physicians and get services that are not part of a network; out-of-network services often require a higher copayment.
• POS: A point-of-service plan is a hybrid of an HMO and a PPO; it is an open-access model that may assign members to a primary care physician and usually provides partial coverage for out-of-network services.

Level of plan coverage. Metal levels indicate the share of covered medical costs paid by the plan versus the share paid by consumers in the form of deductibles, copays, and coinsurance. Generally, premiums are higher when the plan covers a larger share of expenses. 2 “How to pick a health insurance plan: The health plan categories: Bronze, Silver, Gold & Platinum,” healthcare.gov, accessed March 11, 2023.

• Platinum: Plan pays approximately 90 percent of covered expenses.
• Gold: Plan pays approximately 80 percent of covered expenses.
• Silver: Plan pays approximately 70 percent of covered expenses. Some consumers with lower incomes (between 100 and 250 percent of the federal poverty limit) qualify for cost-sharing reductions, which increase the proportion of expenses paid by the plan at no extra cost to the consumer.
• Bronze: Plan pays approximately 60 percent of covered expenses.
• Catastrophic: Plan has very low monthly premiums and very high deductibles, providing protection for high-cost medical situations. Only individuals under 30 or with an exemption based on affordability or other hardship are eligible to purchase catastrophic plans. 3 “How to pick a health insurance plan: Catastrophic health plans,” healthcare.gov, accessed March 11, 2023.

We have collected and analyzed data from every health insurance exchange in the country across the 33 marketplaces on the federal platform and the 18 state-based marketplaces at the county level (see sidebar, “Methodology”). This document includes several insights into the individual market for 2023 that are relevant to stakeholders, including insurers, providers, private equity firms, policy analysts, and consumers:

• Participation continues to grow across almost all insurer categories, as it has since 2018, although the growth rate has slowed in 2023. Participation in 2023 increased most in the national insurance carrier (nationals) category, while participation in the insurtech category declined, driven primarily by the exit of Bright Health. 5 “Bright Health Group announces it will withdraw from the individual market in every state, including California, at the end of 2022,” Covered California, October 18, 2022.
• Consumers continue to have increased choice in product offerings in 2023, given increased insurer participation and an increase in the number of plans offered by participating insurers. Beyond 2023, this trend could be affected by regulations recently proposed by the Centers for Medicare & Medicaid Services (CMS) for federally facilitated marketplaces (FFM), which would limit the number of plans each insurer can offer starting in 2024. 6 “Fact sheet: HHS Notice of Benefit and Payment Parameters for 2024 proposed rule,” CMS, December 12, 2022.
• Plan premiums have increased modestly in 2023 (a median increase of 4 percent for the lowest-price silver plan) following four consecutive years of almost no premium changes. These increases have occurred across insurer categories and metal tiers, although insurtechs increased premiums the most.
• National insurers are offering more competitively priced silver-level plans compared with last year. They currently offer the lowest-price silver option available to 20 percent of consumers, up from 6 percent in 2022. Medicaid insurers and Blue Cross Blue Shield insurers (Blues) continue to provide the lowest-price silver plan option for the largest share of consumers on the individual market (30 percent of and 25 percent of consumers, respectively).

Looking ahead, consumer participation could continue to grow. Open enrollment results from November 1, 2022, through January 25, 2023, show 13 percent growth from 2022. 7 “Fact sheet: Marketplace 2023 open enrollment period report: Final national snapshot,” CMS, January 25, 2023. The upcoming resumption of Medicaid redeterminations, which states may begin as early as April 2023, could result in an estimated additional 2.7 million individuals becoming disenrolled from Medicaid coverage and eligible for individual market premium subsidies. 8 “Unwinding the Medicaid continuous enrollment provision: Projected enrollment effects and policy approaches,” Issue brief HP-2022-20, Office of the Assistant Secretary for Planning and Evaluation (ASPE), HHS, August 19, 2022.

Heading into the 2023 open enrollment period, consumer participation increased to more than 16 million in 2022. Approximately 42 percent of members were enrolled with Blues in 2022, down 18 percentage points from their high in 2014. Insurtechs enrolled 14 percent of members, a 12-percentage-point increase since 2019.