Mark Farrah Associates (MFA) recently released an analysis of trends in membership, claims incurred PMPM, adjusted premiums PMPM, and MLRs for the Individual and Small Group comprehensive medical/health insurance markets. The report, based on data from the National Association of Insurance Commissioners (NAIC) Supplemental Health Care Exhibit (SHCE), also examined the profitability of both health insurance segments over the past five years.
According to the analysis, both the Individual and Small Group segments were profitable for insurers in 2023, with underwriting gains returning to pre-pandemic levels. The Individual segment saw a 28.7% increase in enrollment, reaching 17.7 million members. Premiums PMPM for this segment rose by 2% to an average of $549 PMPM, while the average medical claims PMPM increased by 0.2% to $482 in 2023.
On the other hand, the Small Group segment experienced a decline in membership, dropping by 7.4% to 8.5 million in 2023. Small Group PMPM premiums have been increasing annually by an average of 7.7% since 2020. For more detailed information on the profitability of the Individual and Small Group health insurance markets in
