NAIC annual exhibit data provide glimpse at early enrollment
The recent release of First Quarter (Q1) 2014 data from the National Association of Insurance Commissioners (NAIC) provides an opportunity to look at early enrollment data for some carriers in the non-group market. The reporting series, the Annual Exhibit of Premiums, Enrollment and Utilization (Page 29 of the Annual Statement), provides quarterly data nationally by carrier, and annual data by both carrier and state. Since some carriers only write insurance in one state (e.g., Blue Cross/Blue Shield of Michigan) there is some state data available for Q1 2014.
Top 25 carriers post impressive enrollment gains
A few caveats aside (see below), the NAIC data provide an early glimpse at recent enrollment trends. Table 1 shows cumulative enrollment in the non-group market for 2013 and the first quarter of 2014, overall, and for the top 25 carriers nationally. There are a number of Blue Cross/Blue Shield plans that posted impressive gains, such as the BCBS plans of Michigan, Arkansas, and North Carolina. Guidewell Mutual Holding Corporation (formerly BCBS of Florida) is the fourth largest carrier listed, with Q1 2014 enrollment of over 500,000. Overall, reported enrollment grew from 9.3 million in 2013 to 10.8 million in Q1 2014. Enrollment for these top 25 carriers increased slightly more than 20%, and collectively these carriers accounted for approximately 75% of the non-group market enrollment reported in the Annual Exhibit.
Enrollment by state
Table 2 shows the top three carriers by state, and total reported enrollment by state for 2013. When available, enrollment for carriers whose business is limited to one state is also reported for Q1 2014. Information for California is extremely limited, since there is only one carrier that reports to NAIC from that state. It can be seen that many, but not all state insurance markets appear to be highly concentrated, with a single large carrier. Often this carrier is a Blue Cross/Blue Shield plan. However, these data do not fully represent the market participants in many states. For example, in a number of states there are new carriers who entered the market in 2014, including a number of co-ops. These are not shown in this table since they did not report data in 2013, and are often not in the top three in terms of market share. Additionally, many carriers have announced plans to enter new states in 2015, which should also change the distribution of enrollment in these state markets.
Trends in distribution of non-group market enrollment
Table 3 provides some basic statistics about the distribution of non-group market enrollment for reporting carriers. The 2012 enrollment total seen in Table 2 is approximately 8.8 million. As a comparison, the Current Population Survey in 2012 estimates that approximately 11 million have only non-group coverage, while approximately 19 million estimated have individual coverage in addition to other coverage. Between 2011 and the first quarter of 2014 there is a trend toward larger mean and median enrollment numbers, and in the first quarter of 2014 there was an increase in the number of carriers reporting, reversing the decline that occurred between 2011 and 2013.
About those caveats ...
The Annual Exhibit data presented here do not by any means capture the entire non-group market; however, they do provide some enrollment information on individual carriers. There are a number of limitations, since some carriers do not participate at all, while others file annual, but not quarterly reports. Another caveat is that a considerable amount of the enrollment that occurred late in March is not reflected in the Q1 2014 filing. Additionally, it is not possible to separate Marketplace plans from other non-group market enrollment. The NAIC Supplemental Health Care Exhibit, which is released annually, includes more carriers and provides more detailed information about underwriting and the information needed to calculate preliminary medical loss ratios.
NAIC data versus survey data
There are significant differences between estimates of the individual market enrollment reported by survey data and those reported by administrative data, which have been described in detail elsewhere. Survey estimates of non-group enrollment range from 9 to 25 million depending on the source and definition. One major difference is that with NAIC data it is not possible to distinguish between those who have non-group coverage in addition to other coverage and those for whom non-group coverage is their only source of coverage.
NAIC data versus state data
Data reported to the NAIC for the Annual Exhibit may also differ for various reasons from data reported to state Departments of Insurance. For example, there may be differences in rules about what constitutes different lines of business that could make categories reported to the NAIC inconsistent with those reported to states. One example is the Children’s Health Insurance Program (CHIP) which is treated as individual coverage according to NAIC rules. Therefore there are several carriers included here whose individual enrollment is primarily Medicaid.
Abraham, Karaca-Mandic and Boudreax, http://www.ncbi.nlm.nih.gov/pubmed/23447130; Kaiser Family Foundation, http://kff.org/private-insurance/issue-brief/how-many-people-have-nongroup-health-insurance/ http://www.ncbi.nlm.nih.gov/pubmed/23447130