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Mark Farrah Associates (MFA), www.markfarrah.com, examined trends in membership, claims incurred PMPM (per member per month), adjusted premiums PMPM, and MLRs (Medical Loss Ratios) for the Individual and Small Group comprehensive medical/health insurance markets and segment leaders. Based on an analysis of the National Association of Insurance Commissioners (NAIC) Supplemental Health Care Exhibit (SHCE), MFA also analyzed the profitability of both health insurance segments over the last five years.
The Individual segment presented significant challenges for health insurers in 2025, generating a $5.5 billion underwriting loss.
The Individual segment experienced enrollment loss of 1%, to 21.3 million members for 2025. Premiums PMPM increased 3.1%, to a peak of $577 PMPM. The average medical claims PMPM of $549 in 2025 was an increase of 11.4% from 2024.
Small Group plans reported an underwriting loss of $507.5 million for 2025, down from a $282.6 million gain in 2024.
The Small Group segment continues to lose membership, down another 7.9% to 7.3 million in 2025. Average claims incurred PMPM increased from $537 in 2024 to $590 in 2025, a 10% increase.
