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Individual Major Medical Use Dropped 10% in 2017: Mark Farrah

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Overall use of individual major medical insurance really did fall sharply in 2017, both inside and outside the Affordable Care Act public health insurance exchange system.

The number of people with individual major medical coverage fell to 15.6 million in December 2017, down about 10% from the total in December 2016, according to a report by analysts at Mark Farrah Associates.

A government agency, the Centers for Medicare and Medicaid Services, recently reported that it believes, based on data health insurers sent to a federal risk-adjustment program, that enrollment in individual, fully ACA-compliant coverage may have fallen 11% in 2017, to about 13 million.

(Related: 5 States Where Individual Major Medical Enrollment Was Sad)

Analysts at Mark Farrah use a different source of data: the reports health insurers file with state insurance regulators and managed care plan regulators.

Unlike the CMS risk-adjustment data report, the Mark Farrah report includes data for people who still have “grandfathered” or “grandmothered” individual major medical coverage that has been in effect since before all ACA major medical market rules took effect. Many ACA benefits, plan design and underwriting rules took effect in January 2014.

The Mark Farrah analysts also found that:

  • The total number of people with medical coverage administered by private organizations increased to 265.2 million, from 264.3 million.
  • Employers’ insured and self-insured plans provided coverage for about 67% of the people who had health coverage administered by private organizations in December 2017.
  • Enrollment in Medicare Advantage plans increased 12%, to 61 million, but stayed about the same for insured employer health plans, self-insured employer health plans and managed Medicaid plans.

— Read Individual Health Enrollment Drops 3% on ThinkAdvisor.

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