Using medical loss ratio (MLR) data published by the Centers for Medicare and Medicaid Services (CMS), this report provides a detailed analysis of insurer financial results for the U.S. commercial health insurance market, for both individual and group plans.

Key highlights

• National individual market enrollment increased to 23.6 million in 2024, up from 16.3 million in 2022—nearly a 50% increase.
• Marketplace enrollment increased by approximately 58% from 2022 to 2024, though growth varied widely at the state level based on state Medicaid expansion status and exchange type (federally facilitated exchange or state-based).
• States with the greatest marketplace growth using the federal exchange had larger underwriting gains on average than those operating a state-based exchange.
• The enhanced premium subsidies, set to expire at the end of 2025, are expected to significantly reduce enrollment.
• In the small group and large group fully insured markets, composite MLRs and underwriting margins were relatively consistent in 2022 and 2023.
• MLRs rose by 1.9 percentage points in the small group market and 1.1 points in the large group market.
• Since 2010, neither the small nor large group market has experienced a composite negative underwriting margin.