Individual Market

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.

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.

Mark Farrah Associates just released their semi-quarterly overview of the individual health insurance market. Their data is among the best in the industry, but there's still several important caveats to keep in mind, including an important one which likely went public too late for them to include in their analysis.

According to Farrah's report:

Thanks to David Snow for the heads up!

A couple of weeks ago, both Louise Norris and I crunched the South Carolina data and came up with different estimates of the weighted average requested 2016 rate hikes for the ACA-compliant individual market. She used a worst-case scenario and estimated it to be around 16.8%; I took a slightly more optimistic approach and came up with 15.2%.

Well, the South Carolina Dept. of Insurance just released their approved 2016 rates, and they ended up pretty much splitting the difference.

As you can see, even though there are only 5 carriers operating on the ACA exchange and another 5 offering policies off-exchange only, the overall average is still 15.9% either way: