health isurence usa

Affordable Health Insurance

Top 25 U.S. health insurance companies listed by market share

Understanding which health insurance companies are credible and offer a wide range of products and providers is a good place to start in your quest to provide great health benefits.

Below are the top 25 health insurance companies in the United States listed by size of market share in descending order:

1. 1. United Health
   2. Kaiser Foundation
   3. Anthem Inc.
   4. Centene Corporation
   5. Humana
   6. CVS Health
   7. Health Care Service Corporation (HCSC)
   8. CIGNA
   9. Molina Healthcare
   10. Independence Health Group
   11. Guidewell Mutual Holding
   12. California Physicians’ Service
   13. Highmark Group
   14. Blue Cross Blue Shield of California
   15. Blue Cross of Michigan
   16. Blue Cross Blue Shield of New Jersey
   17. Caresource
   18. UPMC Health System
   19. Blue Cross Blue Shield of North Carolina
   20. Carefirst Inc.
   21. Metropolitan
   22. Health Net of California
   23. Local Initiative Health Authority
   24. Point32Health
   25. Blue Cross Blue Shield of Massachusetts

Source: NAIC

To clarify, the size of the market share doesn’t necessarily correlate with the quality of the product or medical service, nor does it guarantee the company will retain its position throughout the year.

However, market share size is a good indication of competitiveness, financial health, and the structural security of the company, and insurers with higher market shares hold larger direct written premium amounts.

How much do health insurance companies receive in premiums?

During the COVID-19 pandemic, the CDC reported nearly 85 million COVID-19 cases throughout the U.S. As a result, the health industry reported almost a 14% increase—equalling $92 billion—in health benefit claims, which was a big jump compared to prior years.

According to the 2021 NAIC Health Insurance Report1, U.S. health insurers earned approximately $890 billion in total net premiums. This was an 8% increase in premium spending from U.S. consumers over 2020.

United Health, which takes the top spot in our list above, wrote roughly $195 billion in premiums over the past year. Blue Cross Blue Shield of Massachusetts, however, only wrote $8.4 billion. However, both of these companies saw an increase over the last year.

Going forward, the health industry expects continuing increases in medical services needed due to delayed treatment over the past year, worsening health conditions, and older and higher-risk patients needing care.

Considering this, employers of all sizes can better attract and retain their employees by offering a health plan and other additional benefits that will support necessary medical services in the coming years.

Why HRAs and health stipends can be a better option for small employers

With premium prices rising, it can be hard for small and midsize businesses to budget for group health insurance. However, there are more options for employers that can’t afford a traditional health benefit plan. Health reimbursement arrangements (HRAs) are one of those options.

An HRA is a health benefit used to reimburse employees, tax-free, for out-of-pocket medical services, health insurance premiums, and other healthcare expenses. Employers can manage their budget by setting an allowance, and employees can gain more flexibility and freedom over their health benefit.

Below we’ll go over four health benefit plan options that might be right for you and your employees.

Qualified small employer HRA

A qualified small employer HRA (QSEHRA) is a health benefit for employers with fewer than 50 full-time equivalent employees (FTEs) that don’t offer a group health insurance plan. Employers can set an allowance that works for their budget, and employees can pick an insurance policy that works best for them and buy what fits their personal medical needs.

The allowance is flexible and can be used to receive tax-free reimbursements for health insurance premiums and other out-of-pocket costs. If you’re wondering what expenses are eligible for reimbursement, our interactive expense tool includes the complete list of expenses outlined by the federal government in IRS Publication 502.

Individual coverage HRA

Like the QSEHRA, the individual coverage HRA (ICHRA) is a health benefit that can reimburse employees tax-free for individual health insurance premiums and other medical services and expenses.

However, the ICHRA is available for employers of all sizes and can be used as a stand-alone benefit or offered alongside a group health insurance plan, as long as the ICHRA isn’t offered to employees using your group plan.

The ICHRA is customizable, so employers can make it fit their needs by setting different allowance amounts according to 11 employee classes. Employees simply choose to opt-in or opt-out of the benefit before it begins and attest at the beginning of each month that they are still covered by individual health insurance to use the benefit.

Integrated HRA