In the US, there are a host of private healthcare insurance specialists. However, life/annuity and property/casualty insurers also write this coverage, often referred to as accident and health insurance, as outlined by the Insurance Information Institute.
In 2020, the accident and health insurance industry’s direct written premiums reached $1.25 trillion, up by almost 84% from $680 billion in 2011. The largest 10 insurers collectively wrote 55.3% of the total US market, according to the National Association of Insurance Commissioners (NAIC). That is a huge number, although it is not surprising when you consider that health insurance is one of the most common types of insurance.
Listen in: Sign up for our IB Talk podcasts to get the most in-depth insurance discussions
Based on NAIC’s 2020 data, here are the top 10 accident and health insurance groups:
Direct Written Premiums: $176.7 billion
Market Share: 14.1%
A diversified health and well-being company, UnitedHealth Group’s core capabilities are clinical expertise, advanced technology, and data and health information.
UnitedHealth Group serves clients and consumers in the US and more than 130 other countries through two distinct platforms: UnitedHealthcare provides healthcare coverage and benefits services, while Optum provides information and technology-enabled health services. The group invests more than $4 billion in technology and innovation and processes approximately 1.1 trillion transactions annually.
2. Kaiser Foundation
Direct Written Premiums: $104.2 billion
Market Share: 8.3%
Kaiser Foundation Health Plan, Inc. operates as a non-profit healthcare organization. The organization offers allergy, audiology, cardiology, dermatology, oncology, hospice, laboratory, nephrology, occupational therapy, pain management, pediatric rehabilitation, and pharmacy services. The company serves patients in the US.
3. Anthem, Inc.
Direct Written Premiums: $76.9 billion
Market Share: 6.2%
Anthem, Inc. is a health benefits company that is committed to improving lives and communities and making healthcare simpler. Anthem, through its affiliated companies, serves more than 106 million people, including over 42 million within its family of health plans. It aims to be the most innovative, valuable, and inclusive partner.
The group’s affiliated health plans have created various HMOs, PPOs, network-based dental products, various hybrid and specialty products, and health plan services that combine the attributes consumers find attractive with effective cost control techniques. Individual members and employer groups can select from basic and comprehensive plans to meet their specific needs. A wide range of related specialty products and other services is also available, including flexible spending accounts and COBRA administration.
4. Centene Corp
Direct Written Premiums: $75 billion
Market Share: 6%
Centene Corporation, a Fortune 500 company, is a diversified, multinational healthcare company providing a portfolio of services to government-sponsored healthcare programs, focusing on uninsured and underinsured individuals. It operates in 50 states and three international markets and has more than 25 million managed care members.
Centene operates local health plans and provides a range of health insurance solutions. Also, it contracts with other healthcare and commercial organizations to offer specialty services, ranging from behavioral health, dental benefits, life and health, and pharmacy benefits management to care management software, correctional healthcare services, in-home health services, managed vision, specialty pharmacy, and telehealth services.
Direct Written Premiums: $73.9 billion
Market Share: 5.9%
Humana’s cultural foundation is aligned to helping members achieve their best health by providing personalized, simplified, whole-person healthcare experiences. Recognizing that each person, family, and community’s healthcare needs continue to evolve, Humana creates innovative solutions and resources to help people live their healthiest lives on their terms – when and where they need it.
Direct Written Premiums: $69 billion
Market Share: 5.5%
CVS Health is a healthcare innovation company with a purpose to help people on their path to better health. Through its health services, plans, and community pharmacists, it pioneers a new approach to total health.
CVS has more than 9,900 retail locations, nearly 1,100 walk-in medical clinics, a pharmacy benefits manager with about 100 million plan members, a diversified healthcare benefits company serving about 23.4 million medical members, a dedicated senior pharmacy care business serving more than one million patients per year, expanding specialty pharmacy services, and a standalone Medicare Part D prescription drug plan.
Direct Written Premiums: $42 billion
Market Share: 3.4%
Health Care Service Corporation (HCSC), a mutual legal reserve company, is the largest customer-owned healthcare insurance company in the US. The company serves more than 16 million members across five states – Illinois, Montana, New Mexico, Oklahoma, and Texas – and employs more than 23,000 people in over 60 local offices.
HCSC offers a wide variety of life and health insurance products and related services through its affiliates and subsidiaries, including Dearborn Group, Dental Network of America, HCSC Insurance Service Company, Medecision, Availity, Prime Therapeutics, and TriWest Healthcare Alliance.
8. Cigna Health
Direct Written Premiums: $31.8 billion
Market Share: 2.5%
Cigna Corporation is a global health service organization with more than 165 million customer and patient relationships in over 30 countries and jurisdictions. Its insurance plans and products include healthcare insurance for individuals and families, dental insurance plans, Medicare plans, Medicare supplemental plans, other supplemental insurance, and international health insurance.
9. Molina Healthcare, Inc.
Direct Written Premiums: $21.4 billion
Market Share: 1.7%
Molina Healthcare, a Fortune 500 company, exclusively focuses on government-sponsored healthcare programs for qualified individuals and families. The company contracts with state governments and serves as a health plan providing a wide range of quality healthcare services to individuals and families.
Molina provides health plans in California, Florida, Illinois, Michigan, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Washington, Wisconsin, and Puerto Rico. The company also offers a Medicare product and has been selected in many states to join in dual demonstration projects to manage the care for those eligible for Medicaid and Medicare.
10. Independence Health Group
Direct Written Premiums: $20.1 billion
Market Share: 1.6%
Philadelphia-headquartered Independence Health Group, along with its subsidiaries, serves about 10 million clients in 27 states and the District of Columbia. A quarter of its customer network is based in southeastern Pennsylvania. The company serves various employer groups, from small and midsize enterprises to national corporations.
Among the services the insurer offers are commercial, Medicare and Medicaid coverage, pharmacy benefits management, workers’ compensation, and third-party benefits administration. The company is an independent licensee of the Blue Cross and Blue Shield Association.
The United States boasts several top health insurance companies known for their excellent coverage. Here are three leading options:
UnitedHealth Group is a global healthcare company offering comprehensive solutions. They have a significant market presence and provide diverse coverage options.
Kaiser Foundation Health Plan, a non-profit entity, focuses on holistic care and member well-being. They hold a substantial market share and offer comprehensive healthcare services nationwide.
Anthem, Inc. is committed to simplifying healthcare for millions across the U.S. They offer a wide range of healthcare solutions and hold a notable market share.
Considering their premiums and market share, UnitedHealth Group stands out as the health insurance company with the most comprehensive coverage. Their high premiums and extensive market presence reflect a broad spectrum of services and widespread popularity.
UnitedHealth Group further enhances their offerings through clinical expertise and advanced technology.
Remember that the best health insurance choice hinges on individual needs, including health requirements, budget constraints, and preferred healthcare networks. Consulting a qualified insurance advisor can help tailor the selection to specific circumstances.
Each of the mentioned companies caters to a significant segment of the U.S. population, offering diverse coverage options to suit varying needs.
The four most common health insurance plans are:
1. Preferred Provider Organization (PPO) Plan:
2. Health Maintenance Organization (HMO) Plan:
3. Point of Service (POS) Plan:
4. Exclusive Provider Organization (EPO) Plan:
Each plan type has distinct advantages and disadvantages, making the choice dependent on individual preferences and priorities such as provider flexibility, cost considerations, and preferred healthcare networks.
When assessing health insurance costs, premiums can vary significantly due to multiple factors, with the choice of insurance provider and specific plan being critical.
UnitedHealth Group, a prominent industry player, reports annual direct written premiums of $176.7 billion, holding a substantial 14.1% market share.
Designating a health insurance plan as the "most expensive" isn't solely determined by the provider. It heavily hinges on the plan's coverage and individual circumstances.
The high cost of healthcare in the United States stems from a range of contributing factors:
Prudent consumers must thoroughly assess their healthcare needs and financial limitations when choosing a health insurance plan.
Compare different providers, study the terms and conditions, and choose a plan that aligns with both your financial capacity and healthcare requirements.
In the United States, the decision to forgo health insurance may initially appear as a cost-saving measure, but it carries significant risks.
Healthcare costs are high, even when one is covered by insurance. However, those without insurance find themselves at a considerable disadvantage. The inability to access necessary healthcare services and the overwhelming burden of medical bills are two compelling reasons to prioritize coverage.
Those lacking health insurance often face higher expenses for medical treatments that would otherwise be covered by their insurance plans.
In the absence of an insurance company subsidizing healthcare costs, individuals bear full financial responsibility. This can lead to higher charges for identical medical services. When patients are unable to manage these expenses, hospitals or healthcare facilities may resort to legal action.
When making decisions regarding health insurance, it's important to assess your healthcare requirements and financial constraints. Comparing what providers offer and reviewing the terms and conditions of plans can help you find a plan that’s affordable and meets your needs.
Ultimately, many people and families find health insurance to be a good long-term investment. It brings peace of mind and ease in prioritizing their financial and physical health.
(Updated September 13, 2023)