Health insurers’ membership declined 2.8% year-over-year to about 312.5 million people in the first half of 2026, as losses in the individual market and Medicaid outpaced gains in Medicare Advantage and employer-based plans.
The figures come from a Sept. 29 analysis by Mark Farrah Associates, which draws on statutory financial filings with the National Association of Insurance Commissioners, CMS and state agencies.
Five notes:
- Individual market enrollment fell 17.2% to 22 million from 26.5 million, the steepest decline of any segment. MFA attributed the drop primarily to the expiration of enhanced federal subsidies at the end of 2025.
- Medicaid enrollment across managed care and fee-for-service programs fell 5.3% to 73 million, a loss of about 4.1 million beneficiaries. MFA tied the decline there to the pandemic-era redeterminations, along with tighter state eligibility rules and upcoming work requirements under HR 1.
- Employer group risk enrollment, which includes the federal employee health plan, fell 4.3% to about 46.7 million.
- Medicare Advantage enrollment grew 2% to about 35.1 million, an increase of 700,000 members. About 52% of the 70.2 million people eligible for Medicare are now enrolled in a Medicare Advantage plan.
- Self-funded employer plans under ASO contracts added more than 1.1 million members, growing 0.8% to about 135.8 million and accounting for 43.5% of total national enrollment.
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