The individual health insurance market in 2023

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.

Consumer participation increased 25 percent to approximately 16 million from 2020 to 2022,1 coincident with extended enrollment periods2 and enhanced subsidies implemented under the American Rescue Plan Act of 20213 and extended through 2025 by the Inflation Reduction Act of 2022.4

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
  • 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
  • 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 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

The individual marketplace grew to approximately 16 million enrollees in 2022

Enrollment in 2022 exceeded 16 million for the first time since 2016.

Insurer participation continued to grow in 2023, although at a slower rate

Insurer participation increased in 2023 for the fifth straight year.

National insurers expanded participation the most from 2022 to 2023, and insurtechs were the only insurer category to see declines

Exchange participation and consumer access increased across all insurer categories except insurtech from 2022 to 2023.

Consumer choice of insurers and products has increased substantially over the past five years

The proportion of counties with a single insurer decreased from 52 percent in 2018 to 4 percent in 2023.

Growth in product availability has varied by plan type and metal tier

The availability of managed care plans has steadily grown since 2014, and gold plan offerings increased in 2023.

Rates for plans increased in 2023 across metal tiers and plan categories

Across all metal tiers, premiums have increased between 2022 and 2023.

Premium changes varied by insurer type

National insurers improved their price position in 2023

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