Competition Has Increased in the Individual Market in Recent Years But Fallen in Fully Insured Group Markets
Commercial health insurance markets remain highly concentrated across coverage types. However, the individual market, which consists mostly of the ACA Marketplaces, has attracted more insurers and witnessed greater insurer competition across a variety of measures since the implementation of the enhanced premium tax credits in 2021, according to KFF's new analysis. For example, from 2020 to 2023, the average market share of the largest insurer in each state's individual market declined from 60% to 53%, corresponding with enrollment growth in the ACA Marketplaces driven by the enhanced premium tax credits.
By contrast, fully insured employer-sponsored health insurance markets have become less competitive in the past decade. Several market competition indices show there is now more competition in the individual market than in fully insured group markets. The analysis presents 2013-2023 enrollment and market competition data for fully insured and individual plans both nationally and on a statewide basis.
When citing our work, please note our name is KFF, which is our legal operating name. We should be cited as KFF, a nonprofit health policy research, polling, and news organization. We no longer use the name Kaiser Family Foundation.
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