Mark Farrah: 19.5M enrolled in total Individual Market as of March 2023 (w/caveats)

Mark Farrah Associates is an electronic publisher of business information and analytics for the U.S. healthcare industry; they aggregate industry data and market metrics for their own database products that they sell on a subscription basis.

They typically release state-level breakout estimates of the total U.S. individual market once or twice a year. They haven't done so in 2023 as of yet, but today they did release this overview analysis:

While the individual health insurance market has faced challenges over the years, first quarter 2023 enrollment (1Q23) is nearing levels not seen in almost a decade. According to financial statements filed by insurers, and with estimates by Mark Farrah Associates (MFA), enrollment in individual medical plans, both on and off the exchange, totaled approximately 19.5 million as of March 31, 2023, nearing the height of the market in early 2015. In this brief, MFA provides insights into overall enrollment and financial trends for the individual health insurance segment, while identifying notable market developments in Florida and Texas, the largest individual markets in the US.

The main takeaway is that 19.5 million figure, which they claim is still slightly shy of an all-time high individual market enrollment tally of 20.4 million back in March 2015. However, it's important to remember that in addition to the ACA exchange market, that total also included off-exchange ACA-compliant coverage as well as so-called "grandfathered" and "transitional" plans, some CHIP enrollees (apparently some states put children into subsidized individual market policies as part of their CHIP program for whatever reason, similar to Arkansas' "private Medicaid option"), and so-called "short-term, limited duration" plan enrollees.

What's interesting about today's overview by Mark Farrah is that short-term plans aren't listed as being included in the 19.5 million figure.

Here's how it was worded back in July 2020, when the total market was only estimated at 14.9 million people:

Furthermore, individual enrollment includes short term plan enrollees and may include Medicaid programs, such as CHIP, as some states include subsidized lines in the individual segment.  These factors may have resulted in moderate understatement or overstatement of enrollment.

Here's how a similar paragraph is worded today:

Furthermore, individual enrollment may include Medicaid programs, such as CHIP, as some states include subsidized lines in the individual segment. These factors may have resulted in nominal understatement or overstatement of enrollment.

I don't know if the decision not to include short-term plan enrollees was deliberate or an oversight, but I find it interesting. The CHIP number is likely pretty small, and there aren't too many grandfathered or transitional plan enrollees left these days (less than half a million, I'd estimate), so if short-term plans aren't included, that likely puts the ACA-compliant individual market (on + off-exchange only) at close to 19 million today. Huh.

Unfortunately, they didn't include a state-level or on/off-exchange breakout today; hopefully that will be coming soon.