A look back at 2022 growth dynamics as a handful of exchange plans announce their 2023 plans.
The 2022 plan year saw record growth: per CMS, nearly 14.5 million enrollees with close to 3 million being first-time exchange customers. Aetna, a CVS Health company, re-entered the exchange for the first time since 2018, and nearly all of incumbent and startup plans alike expanded per the Robert Wood Johnson Foundation's (RWFJ) 2022 analysis.
Among startup plans:
- Bright HealthCare — Entered five new states (California, Illinois, Texas, Utah, and Virginia) for a total of 16, with expanded service areas in North Carolina and Tennessee.
- Friday Health Plans — Tripled their enrollment to more than 300,000 members by entering Georgia, North Carolina, and Oklahoma for a total of seven states.
- Oscar Health — Expanded into three new states as a standalone brand (Arkansas, Illinois, and Nebraska) and three additional states as part of co-branded Cigna+Oscar plans (Kansas, Missouri, and Tennessee).
Among traditional plans:
- Centene — Entered four states including New Jersey, which RWJF reported "hadn't had a new insurer since Oscar returned to their market in 2018."
- Cigna — Added two new states (Georgia and Pennsylvania) for a 2022 total of 13.
- Molina Healthcare — Entered Idaho, Illinois, and Kentucky.
- UnitedHealthcare — Entered seven new states (Alabama, Florida, Georgia, Illinois, Louisiana, Michigan, and Texas), bringing its 2022 state footprint to 18.
Slow and steady wins the race
Even with enrollment and market expansion, RWJF assessed that plan growth was less rapid in 2022, with author Katherine Hempstead noting: "This year [2022], we see more robust growth in enrollment, but some moderation in issuer participation trends. To support, Hempstead added: "While the total number of plan offerings increased about one third in 2021 (from 10,289 to 13,596), this year's increase to 15,638 constitutes growth of about 15%."
Two additional observations for slower-paced growth concerned Aetna's re-entry, other plans that expanded modestly or not at all, and those that left states in 2022.
RWJF noted that Aetna took "a comparatively modest foray into a little more than 300 counties" in rejoining the marketplace" and in a total of eight states — adding that this "is consistent with the pattern exhibited by United Health Group, when they recently returned to the marketplace in a very slimmed down form."
In 2022, Molina "made modest entries into Idaho, Illinois, and Kentucky" while Anthem, now known as Elevance Health, did not expand at all.
What we know about 2023
It remains to be seen what combination of enrollment growth and plan market pacing will emerge for 2023. Among the plans that have announced their new exchange offerings, there is a mix of expansion and contraction:
- Bright HealthCare announced it will exit six states in 2023 — New Mexico, Oklahoma, South Carolina, Illinois, Utah, and Virginia — leaving the latter three after just one year.
In a communication to brokers, the plan stated: "Bright Health is taking steps to refine and optimize our strategy to ensure we are best positioned to enhance the health care experience for consumers and Care Partners and deliver the highest quality, affordable care. In 2023, we will deepen our presence in those markets where we can have the greatest impact, achieve long-term success and drive differentiated value with our Fully Aligned system of care.
- Oscar Health will also be exiting states in 2023 (Arkansas and Colorado) while expanding in others.
- Cigna will continue to expand in 2023, entering Texas, Indiana, and 50 additional counties in Georgia, Mississippi, and North Carolina. In its press release, Cigna's president of U.S. government business Charles Berg noted the plan's consistent marketplace presence since 2014 and the potential for it to reach nearly 730,000 new customers through its 2023 expansion.
Returning full circle to the theme of health plan paced growth, Aetna's second year back on the exchange will see it enter select counties in four more states — California, Delaware, Illinois, and New Jersey — plus county expansion in the eight states it entered in 2022.
Several large insurers have yet to announce their 2023 plans, including UnitedHealthcare and Elevance.
Laura Beerman is a contributing writer for HealthLeaders.
KEY TAKEAWAYS
The 2022 exchanges set records for enrollment, including nearly 3 million first-time customers.
A lookback at marketplace analysis, however, notes careful and slightly slower expansion strategies at the individual insurer level.
Plan announcements for 2023 already reflect a mixed bag, including expansion, retreats, and dial-backs.