Individual and Small Group Health Insurance Segments Post Losses in 2025
Event summary
- The Individual health insurance segment reported a $5.5 billion underwriting loss in 2025, with enrollment declining by 1% to 21.3 million members.
- Premiums PMPM for the Individual segment increased by 3.1% to $577, while medical claims PMPM rose by 11.4% to $549.
- The Small Group health insurance segment experienced a $507.5 million underwriting loss in 2025, reversing a $282.6 million gain in 2024.
- Small Group enrollment dropped by 7.9% to 7.3 million members, with claims incurred PMPM increasing by 10% from $537 to $590.
The big picture
The 2025 underwriting losses in the Individual and Small Group health insurance segments highlight ongoing challenges in balancing rising medical costs with premium pricing. These trends reflect broader industry struggles with affordability and accessibility, particularly as insurers navigate regulatory environments and competitive pressures.
What we're watching
- Market Dynamics
- How rising medical claims PMPM will impact future premium adjustments and profitability in both segments.
- Regulatory Impact
- Whether NAIC regulations will influence insurers' strategies to mitigate losses in the Individual and Small Group markets.
- Competitive Shifts
- The pace at which health insurers adapt their offerings to stabilize enrollment and improve financial performance.
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