In which major Insurer earnings reports confirm everything I've been warning about (with important update/correction)

via Amy Lotven of Inside Health Policy:

Key Insurers Expect To Lose Nearly 3M Combined ACA Enrollee By End Of 2026

Key publicly traded insurers reported in recent earnings calls that they expect to lose nearly 3 million enrollees combined by the end of 2026, buoying stakeholders’ fear that the loss of the enhanced tax credits will drive more people from the marketplace than the 1 million fewer signups reported by CMS

While CMS’ mid-January snapshot showed that about 1 million fewer people enrolled in an Affordable Care Act plan during open enrollment compared to last year, insurers in recent earnings calls are echoing state exchange officials’ belief that true results will take time, and four large companies reveal they expect at least 2.8 million fewer ACA exchange consumers.

Also, in line with comments from state exchange officials, carriers are seeing more consumers enrolled in less-expensive bronze plans, which have higher co-pays and deductibles.

The carriers referenced include:

• Centene expects to only have 3.5 million enrollees by the end of March, down 1.5 million from a year earlier

That would be a 30% net drop of effectuated enrollment vs. March 2025.

• Elevance expects to end 2026 with 400,000 fewer enrollees

From the earnings call transcript, they expect to have 'at least' 900,000 ACA individual market enrollees at the end of the year...which taken literally would also mean a 31% net drop.

• UnitedHealthcare expects to be down 500,000 enrollees (I don't know what this is down from)

• Molina expects to be down 430,000 enrollees

This wolud be down from 650,000 enrollees as of the end of 2025...that's a 66% drop in enrollment although part of this is because they pulled out of about 20% of their markets.

NOTE: This section on Oscar Health has been updated/corrected

• Oscar Health, on the other hand, had their earnings call the day after this article was published:

The 2026 open enrollment period was a record for the company. Oscar delivered another year of above-market growth, and we are privileged to serve 3.4 million members as of February 1, 2026. We expect to start the second quarter with approximately 3 million paid members, a 58% increase year-over-year.

They then say:

We ended the year with approximately 2 million members, an increase of 22% year-over-year.

In other words, that’s a combined enrollment drop of 2.83 million across the first four carriers…but a net enrollment increase of around 1.0 million for Oscar, give or take. Combined, that’s a drop of around 1.83 million year over year for these 5 companies, which comprise nearly 50% of the total ACA market, assuming UnitedHealthcare had around 2 million enrollees total last year.

Extrapolated literally, this would amount to something like ~3.7 million total enrollees losing coverage by the end of 2026, although it’s obviously not quite that simple.

Oscar also goes on to note that…

…a lot of people have changed their plan signs…in our book, we saw silver drop in half as a percentage of what it was before and bronze increase by almost 50% and gold almost quadruple. And that's the kind of shift we saw in our membership mix. That means people are carrying higher deductible plans.

It's still a major red flag which supports everything I've been warning about for months now.

Some in the media have pointed out that topline numbers are still high, but that assumes that people who select plans will stick around. Many of the passively enrolled consumers who see higher premiums will not renew, Keim said. “They'll go into grace periods and not pay, and they'll eventually fall off. That'll be much bigger than in past years, just given the price dynamics in the market.”

This is literally what I've been saying all along.

Molina also saw a material change in metal tier coverage, with about 50% of enrollees selecting silver plans down from 70% in most years. This shift could affect enrollment due to higher co-pays and deductibles, but Keim doesn’t expect results to be much different from normal attrition. The insurer does expect much lower enrollment through special enrollment periods compared to 2025, Keim said.

Again, this is exactly what I've been warning for some time now.

United Healthcare told investors that it will lose millions of consumers this year across most of its products, including 500,000 fewer ACA marketplace enrollees.

United officials said they continue to work with CMS on affordability challenges in the marketplace and reiterated their pledge made during a recent congressional hearing to return ACA--related profits to consumers.

Be on the lookout for a potential bait & switch here: It's conceivable that the "profits" they "return to consumers" may end up just being the same profits they're already legally required to return to enrollees in the form of Medical Loss Ratio rebates.

Centene CEO Sarah London reminded investors the company had assumed the loss of the enhanced tax credits in its exchange pricing and the 1.5 million loss tracks with expectations. She also stressed that the publicly reported ACA signup numbers are not the most helpful indicator of marketplace dynamic.

Now that it is February, paid membership is the best metric for forecasting and planning, Norwood said. Through January, payment rates were lower than historical levers but in line with Centene’s expectations for a marketplace without the higher ACA tax credits.

...Centene has also clocked a shift to bronze-level coverage compared to prior years and notes that enrollees can still access $0 premium plans. Bronze membership will represent a little over 30% of its marketplace enrollment this year compared to a range of 19 to 24% over the past four years.