HIX Enrollment: A State-Level View of Exposure, Attrition, and Acuity Risk

Research evidence excerpt

HIX Enrollment: A State-Level View of Exposure, Attrition, and Acuity Risk

SCR had the lowest

expected attrition at (7.2%) and (8.7%). Despite concerns around fraud-related eligibility reviews, FL,

GA, and TX have held up relatively well from an attrition perspective, ~(7-9%) YTD and below the

HIX market avg of (10.8%), providing an unexpected tailwind for carriers with material exposure to

these markets. Notably, these figures reflect fairly mild disenrollment, but only include data through

Feb. Further disenrollment is expected through '26.

Disenrollment Experience vs. Guidance (Ex 1). Based on current state-level attrition data and our

assumption of (1.1%) monthly attrition through year-end, we estimate FY disenrollment of ~(18–

24%) across most carriers. However, pricing appears to be driving meaningful market share shifts.

CNC and MOH, which implemented larger rate increases, saw the greatest disenrollment through

1Q, broadly in line with guidance. Conversely, OSCR and ELV, which priced more competitively,

reported YTD enrollment growth of approx +55% (OSCR 1Q rptd) and +1% (ELV 2Q rptd),

respectively. While OSCR's growth appears to be tracking above expectations, ELV diverges from

guidance the most, contemplating ~(20%) enrollment declines for '26 in the 2Q guidance update,

but reporting YTD membership growth through 1H.

ELV - Why No Favorability Vs Guide? With effectuated membership ~flat from 4Q25 to 2Q26,

getting EOY26 membership down to 1.05M (mgt: "above 1M") requires 3.3% net attrition per month

in 2H. That's possible; underlying churn was 3-4% per month before COVID. But mgt must also be

assuming minimal gross adds, which seems unlikely given its position as market share gainer. The