HealthIntel Weekly: Competition Rises in Individual Market, Falls in Group Plans
Welcome to HealthIntel Weekly. Every week, we pull together the latest health care reports, research, and upcoming webinars so you don’t have to dig for them.
What’s New:
The ten largest insurers cover more than half of all enrollees in private insurance, Medicaid Managed Care and Fee-for-Service Medicaid programs, and Medicare Advantage plans in 2025, according to a new KFF analysis. From 2013 to 2023, enrollment in fully insured group plans fell by roughly 14 million, while self-funded group enrollment grew by about 16 million. Several states have a single insurer dominating their markets. Only Georgia, New York, Washington and Wisconsin have no insurer exceeding a 50% market share across all market segments and instead have multiple insurers with comparable shares. The analysis also shows that fully insured group markets have become increasingly concentrated, while competition in the individual market has strengthened since 2020. In 2023, most fully insured large group (48 states and Washington D.C.), fully insured small group (all 50 states and Washington D.C.) and individual markets (47 states and Washington D.C.) were highly concentrated, with a Herfindahl-Hirschman Index exceeding 1,800.
At least 16.8% of total commercial enrollees, about 96.5 million people, are in plans that must count any form of copay assistance toward patient cost-sharing limits as of September 2025, according to an Avalere Health analysis. Since 2019, twenty-five states, Washington D.C. and Puerto Rico have enacted laws prohibiting payers and pharmacy benefit managers from using copay accumulator programs. As scrutiny and restrictions on such programs have grown, the analysis notes that stakeholders are increasingly turning to alternative funding programs to manage exposure to specialty and other high-cost drugs. These programs carve out certain specialty products from prescription drug coverage for patients that qualify for patient assistance.
Keeping the enhanced Affordable Care Act subsidies in place would raise the federal deficit by nearly $83 billion over 10 years but keep millions more people insured, according to the Congressional Budget Office. The agency estimates that, compared with allowing the subsidies to expire, the number of insured people would rise by 0.4 million in 2026, 3.0 million in 2027, 4.0 million in 2028, and 1.1 million in 2029. CBO also projects that gross premiums for benchmark plans would be 5.7% lower in 2027, 9.0% lower in 2028, and 3.3% lower in 2029 if the subsidies are extended. As of Nov. 29, 2025, more than 5.7 million ACA enrollees have selected or actively renewed a marketplace plan, according to CMS.
Next Up:
Drug Channels Outlook 2026
Drug Channels Institute, Dec. 12, 2025, 12 p.m. (ET)
Speaker:
Dr. Adam J. Fein, president of Drug Channels Institute and the author of Drug Channels
Improving Anaphylaxis Outcomes: Approaches for Enhancing Access to Epinephrine
Margolis Institute for Health Policy, Dec. 16, 2025, 9 a.m. (ET)
Panelists:
· Brian Canter, PhD, Assistant Research Director
· Madi Cordle, Policy Research Assistant
· Valerie J. Parker, MSc, Assistant Research Director
· Thomas Roades, MPP, Policy Research Associate
Continuous Glucose Monitors: How Coverage Compares to Recommended Care for People with Diabetes
Georgetown University’s Center on Health Insurance Reforms, Dec. 16, 2025, 1 p.m. (ET)
Panelists:
Amy Killelea, JD, Assistant Research Professor at Georgetown University’s CHIR
Aaron Turner-Phifer, Senior Director of Health Policy at Breakthrough T1D
Euguene E. Wright, Jr., MD, Medical Director of Performance Improvement at South Piedmont Area Health Education Center
2026 Life Sciences and Health Care Outlook: Trends Shaping Transformation
Deloitte, Dec. 18, 2025, 11 a.m. (ET)
Panelists:
Kulleni Gebreyes, principal, Deloitte Consulting LLP
Alicia Janisch, partner, Deloitte Tax LLP
Pete Lyons, principal, Deloitte Consulting LLP
Jay Bhatt, managing director, Deloitte Services LP (host)