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Report

Commercial health insurance: Detailed 2023 financial results and emerging 2024 and 2025 trends

31 July 2025

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.

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About the Author(s)

Paul Houchens

Clay Holman

Zach Hunt

Gordon Chan

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