If you’re interested in offering a group health plan or you’re an individual looking to purchase a plan on the exchanges, understanding which health insurance companies are credible and provide a wide range of products and medical providers is an excellent place to start searching for coverage.
One way to rank health insurance companies is by market share or size. Market share reflects a company’s percentage of the health insurance market.
Below are the top 25 health insurance companies in the United States listed by market share size in descending order, according to NAIC3.
| Rank | Company | Market share in 2022 | Market share in 2023 |
| 1. | UnitedHealth Group (including UnitedHealthcare) | 15.34% | 16.37% |
| 2. | Elevance Health Inc. (formerly Anthem) | 7.16% | 7.08% |
| 3. | Centene Corp. | 6.68% | 6.76% |
| 4. | Humana | 6.03% | 6.61% |
| 5. | CVS Health (including Aetna Health) | 5.82% | 6.43% |
| 6. | Kaiser Foundation (Kaiser Permanente) | 6.18% | 6.19% |
| 7. | Health Care Services Corporation (HCSC) | 3.53% | 3.65% |
| 8. | Cigna Health | 2.39% | 2.64% |
| 9. | Molina Healthcare Inc. | 1.99% | 2.04% |
| 10. | GuideWell (including Florida Blue) | 1.84% | 1.91% |
| 11. | Independence Health Group Inc. | 1.76% | 1.85% |
| 12. | Highmark Group | 1.32% | 1.32% |
| 13. | Blue Cross Blue Shield of Michigan | 1.11% | 1.20% |
| 14. | Blue Cross Blue Shield of New Jersey | 1.11% | 1.11% |
| 15. | UPMC Health System | 0.90% | 0.95% |
| 16. | Blue Cross Blue Shield of North Carolina | 0.79% | 0.82% |
| 17. | Caresource | 0.93% | 0.77% |
| 18. | Health Net of California, Inc. | 0.63% | 0.75% |
| 19. | Local Initiative Health Authority | 0.61% | 0.73% |
| 20. | Carefirst Inc. | 0.70% | 0.72% |
| 21. | Metropolitan | 0.69% | 0.65% |
| 22. | Blue Cross Blue Shield of Massachusetts | 0.60% | 0.61% |
| 23. | Blue Cross Blue Shield of Tennessee | Not in top 25 in 2022 | 0.61% |
| 24. | Point32Health Inc. | 0.63% | 0.57% |
| 25. | Health Net Community Solutions | Not in top 25 in 2022 | 0.55% |
Market share size 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 indicates competitiveness, financial health, and the structural security of the company, and insurers with higher market shares hold larger direct written premium amounts. They may also have a more extensive network of providers.
How much do health insurance companies receive in premiums?
According to the 2023 NAIC Health Insurance Report, U.S. health insurers earned approximately $1.08 trillion in total net earned premiums4. This was an 8% increase in premium spending from U.S. consumers from 2022 at $1 trillion.
UnitedHealth, which tops our above list as the largest insurer, wrote roughly $248 billion in premiums in 2023. In contrast, Health Net Community Solutions wrote $8.35 billion.
National health professionals in the insurance industry expect increases in medical services needed due to inflation, 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 range of health insurance options and other extra benefits, such as wellness healthcare programs, to support their employees’ future need for medical services.
| ank | Health insurer | Direct written premiums in 2023, according to NAIC |
| 1. | UnitedHealth Group (including UnitedHealthcare) | $248,763,012,672 |
| 2. | Elevance Health Inc. (formerly Anthem) | $107,650,449,800 |
| 3. | Centene Corp. | $102,711,951,802 |
| 4. | Humana | $100,521,046,979 |
| 5. | CVS Health (including Aetna Health) | $97,614,161,371 |
| 6. | Kaiser Foundation (Kaiser Permanente) | $94,124,863,877 |
| 7. | Health Care Services Corporation (HCSC) | $55,500,353,206 |
| 8. | Cigna Health | $39,580,464,561 |
| 9. | Molina Healthcare Inc. | $30,942,107,198 |
| 10. | GuideWell (including Florida Blue) | $28,978,443,339 |
| 11. | Independence Health Group Inc. | $28,166,663,550 |
| 12. | Highmark Group | $20,065,837,533 |
| 13. | Blue Cross Blue Shield of Michigan | $18,237,327,366 |
| 14. | Blue Cross Blue Shield of New Jersey | $16,946,943,535 |
| 15. | UPMC Health System | $14,401,481,471 |
| 16. | Blue Cross Blue Shield of North Carolina | $12,436,855,017 |
| 17. | Caresource | $11,772,153,985 |
| 18. | Health Net of California, Inc. | $11,333,568,476 |
| 19. | Local Initiative Health Authority | $11,103,818,952 |
| 20. | Carefirst Inc. | $10,966,814,963 |
| 21. | Metropolitan | $9,848,831,313 |
| 22. | Blue Cross Blue Shield of Massachusetts | $9,310,416,288 |
| 23. | Blue Cross Blue Shield of Tennessee | $9,294,215,169 |
| 24. | Point32Health Inc. | $8,686,051,746 |
| 25. | Health Net Community Solutions | $8,355,680,878 |
Why HRAs and health stipends are a better option for small employers
it can be difficult for small and midsize businesses to budget for group medical insurance. Small organizations may also have trouble meeting minimum participation requirements. However, more health insurance options exist for organizations that want to break free from traditional benefits. HRAs are one of those options.
An HRA is a health benefit you can use to reimburse employees, tax-free, for out-of-pocket medical services, health insurance premiums, or a combination of the two. With an HRA, you set a monthly allowance that your employees can spend on healthcare costs. Once employees make an approved purchase, you reimburse them up to their allowance amount.
Below, we’ll go over four alternative health benefits that might be right for your organization.
Health stipend
Your last option for an alternative benefit plan is a taxable health stipend. The federal government doesn’t regulate stipends as much as other traditional health benefits. They also have no contribution limits and can work for companies of all sizes. So, stipends may be more affordable and easier to administer for some employers, especially small business owners.
Stipends are a flat amount of money given to employees to spend on medical expenses, such as a health insurance policy (including supplemental plans, like dental insurance and vision coverage) and other out-of-pocket medical expenses. You can offer them alongside any type of health benefit, whether that’s a traditional group health plan or an HRA.
The IRS considers stipends as extra wages added to your employees’ paychecks. This makes the amount taxable at the end of the year, but your employees will have more choice in how they can spend their stipend money.
It’s important to remember that health stipends don’t satisfy the employer mandate for ALEs. If you’re an ALE, you must offer a group plan or an ICHRA in addition to your health stipend to meet the employer mandate requirements or be subject to costly penalties.
How PeopleKeep can help you provide individualized employee benefits
HRAs and health stipends are excellent ways to provide a comprehensive health benefit as a small business. But you might be wary about administering them on your own. Luckily, PeopleKeep’s health benefit administration software can help you administer your HRA or health stipend quickly and easily.
PeopleKeep’s HRA solutions give employers a simple and effective platform to manage their benefits. Our team of experts helps you manage your plan details and automates time-consuming tasks, like reviewing reimbursement requests and updating benefit plan documents. That way, you don’t have to worry about self-administration or making compliance errors.
From helping you design your benefit plan to award-winning customer support for your employees, PeopleKeep has what you need to add affordable and customizable benefits to your compensation package.
Conclusion
While the number of health insurance companies offers employers many ways to offer a traditional group health benefit, it’s essential to consider other, more flexible options.
HRAs and health stipends are an easy way to offer affordable health benefits without diving head-first into the waters of group plan administration. They also give your employees the autonomy to choose the right health policy for them. If you’re an employer considering an HRA, we would love to help you get started.
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