Over at KFF (previously the Kaiser Family Foundation), researchers/analysts Jared Ortaliza, Krutika Amin & Cynthia Cox have put together a new analysis of the overall individual (aka non-group) U.S. health insurance market as of early 2023. While ACA exchange-based enrollment is publicly available (for both subsidized & unsubsidized enrollees) and is the primary focus of this website, off-exchange enrollment is always somewhat fuzzier for several reasons:

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:

Wax On Wax Off

It's been nearly a year since I've checked in on what the off-exchange individual health insurance market looks like. In October 2021, Mark Farrah Associates estimated the total indy market (including both on- and off-exchange enrollees) at around 15.9 million people nationally as of June 2021. Of that, they figured roughly 75.4% of it was on-exchange vs. 24.6% off-exchange.

However, as I noted at the time, there were a couple of important caveats with Mark Farrah's estimates, two of which they mentioned but one of which they didn't:

It is important to note that Mark Farrah Associates (MFA) applied enrollment figures for select carriers not required to report health enrollment on a quarterly basis and made other adjustments based on market analysis. 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.

Wax On Wax Off

Back in September, the Centers for Medicare & Medicaid Services (CMS) issued several reports which touted the success of the 2021 COVID Special Enrollment Period. Thanks in part to enrollment being re-opened but mostly to the dramatically expanded financial aid provided by the American Rescue Plan (ARP), over 2.8 million additional Americans signed up for 2021 healthcare coverage via the ACA exchanges nationally.

This came on top of the 12.0 million who had already enrolled during the official 2021 Open Enrollment Period from November 1st, 2020 - January 31st, 2021. All told, that's 14.8 million Americans who selected Qualified Health Plans (QHPs) via the exchanges through mid-August.

Ever since I started this venture, one of the most difficult types of data for me to hunt down have been the ever-elusive off-exchange individual market enrollment numbers.

Off exchange data is extremely difficult to come by for several reasons. First, because unlike enrollments via the ACA exchanges, off-exchange enrollment data is a purely private transaction between individuals and private corporation. Yes, publicly traded companies have to provide some level of data in their quarterly & annual reports, but that data usually focuses on the financial side. Yes, they generally do give some info about how many enrollees they have, but they don't always break out the individual market specifically...and when they do, they often don't distinguish between the on and off-exchange numbers. Finally, even when they do break it out into that much detail, you'll be hard pressed to find a carrier who breaks the numbers out by state (unless they only operate in one or two states to begin with).

This is a quick be honest, it's mainly here just to remind myself to refer to the link again for a later project. But I just wanted to remind everyone that in addition to the exchange-based Qualified Health Plan listings at HealthCare.Gov (which cover 38 states) and the rate review database where you can search through the proposed (and, eventually, approved) rate hikes for every ACA-compliant individual or small group policy by carrier, there's also a third database: The Plan Finder.

Welcome to Plan Finder

This Plan Finder website is provided by the federal government to help you find private health plans available outside the Health Insurance Marketplace. We want you to find health insurance that best fits your budget and meets your needs.

This may seem like common knowledge now, but in 2014, it felt like I was one of the only people who recognized that there were millions of people enrolling in ACA-compliant policies off of the ACA exchanges, directly via the insurance carriers themselves. My best estimate for 2014 was that in addition to the 7 million or so exchange-based individual market enrollees, there were another roughly 8 million people who enrolled off-exchange (although several million of those were in non-ACA compliant policies).

Right on top of the Humana SEC filing I just wrote about comes this Q2 earnings conference call with Joe Swedish of Anthem (formerly WellPoint), which is an even larger insurance company nationally:

Our growth continues to be balanced so far in 2015 as we added 571,000 Medicaid members, 331,000 national members, 51,000 individual members and 16,000 local group members. As a reminder, we closed on the Simply Healthcare acquisition in February of this year, which contributed 209,000 members. These results have been supported by strong operating cash flow of $2.8 billion year-to-date, which represents 1.6 times net income.

Humana Group is one of the largest health insurance companies in the country. As such, their enrollment data being made available is extremely helpful in seeing where things stand and how they've changed nationally.

Today, Bob Herman of Modern Healthcare provided me with a link to Humana's latest SEC filing. In addition to a whole mess of financial info which is of little interest to me, there's also all sorts of year-over-year data about their enrollment numbers...including a very handy section about their individual market, broken out by ACA exchange-based, Off Exchange and even their non-ACA compliant enrollments (ie, "grandfathered" and/or "transitional" enrollees).

Here's the key section: