Data from the Department of Managed Health Care and the California Department of Insurance show that total health insurance enrollment in 2022 increased by 4.7% (1.6 million) to a record total of 35.9 million enrollees. This compares to a growth of 1.4% in 2021.
Although Medi-Cal managed care was the largest driver of 2022 enrollment gains, enrollment increased or remained the same in all markets except the individual market. (See Figure 1.) In 2022, Medi-Cal managed care enrollment (13.0 million) exceeded enrollment in the large group market for the third year in a row.
Medi-Cal Managed Care Growth Remains Strong Under Continued Coverage Requirements
Medi-Cal managed care enrollment grew by 10.7% (1.3 million) in 2022, surpassing 13.0 million by the end of the year. (See Table 1.) This is the third consecutive year of strong growth in Medi-Cal and follows increases of 9.2% (927,000) in 2021 and 7.2% (795,000) in 2020 (left shown). The current Medi-Cal managed care growth period begins in April 2020, coinciding with federal requirements for continued coverage during the COVID-19 public health emergency. With most disenrollments halted, Medi-Cal managed care enrollment expanded by three million people over three years, from December 2019 to December 2022. Moving into 2023, the eligibility review continues, and Medi-Cal enrollment is expected to decline.
Employer-Sponsored Insurance Enrollment Grows Modestly, Led by ASO
Enrollment in administrative services only (ASO) arrangements for self-insured employers increased by 5% (273,000) in 2022. (See Table 1.) Enrollment growth in the group market is positive but less than 1%. Small group enrollment increased by 0.8% (17,000) to 2.3 million in 2022. Large group enrollment increased by 0.5% (43,000) to 9.5 million in 2022. Overall, enrollment in employer-sponsored insurance markets (ESI) reached 17.6 million in 2029, an increase of 29% (333,000) from last year. (See Figure 2.) By comparison, jobs grew 3.6% over the same period. (ESI markets are defined as large group, small groups, and ASO.)
Individual Market Enrollment is denied.
The individual market ended in 2022 with 2.2 million enrollees, down 5.1% (119,000) from 2021. This is compared to the strong growth in 2020 (9.7%) and 2021 (6.7%). The 2022 enrollment decline occurs in Covered California, where eligible enrollees can get federal premium subsidies, and outside of Covered California. (See Figure 3.) The decline in individual enrollment through Covered California occurred despite the availability of enhanced federal subsidies and a penalty for the uninsured. The need for individual coverage may be reduced due to increased enrollment in Medi-Cal and ESI.
Medicare-managed care continues to Grow
Medicare managed care enrollment grew 5% (145,000) to reach 3.1 million total enrollees. (See summary table under document downloads.) About two-thirds of the growth came from SCAN (51,000), Kaiser (30,000), and CVS/Aetna (16,000). (See the latest California Health Care Almanac on health insurance enrollment for market and insurer details.)
Legacy Plan Enrollment Denied More
Enrollment continues to fall under legacy (formerly “grandfathered”) plans, those implemented before the Affordable Care Act was passed. (See Figure 4.) When 2022 ended, 925,000 commercial enrollees, or 6.1% of the market, remained in legacy plans, up from one million legacy enrollees in 2021.
With the end of the federal public health emergency in 2023, the unwinding of Medi-Cal’s continuous enrollment policies is expected to result in two to three million enrollees leaving the Medi-Cal program. Most may qualify for other forms of coverage. The extent to which these enrollees are switching to individual or group insurance is not yet known. It is important to closely monitor enrollment levels among different sources of coverage as well as the uninsured rate in 2023 and 2024.