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Navigating the landscape of health insurance options can be daunting for employers, individuals, and families alike. Choosing the right coverage involves understanding market dynamics, company reputations, and available plans. With the complexity of the healthcare industry, it’s crucial to analyze credible insurers that offer extensive networks, competitive rates, and reliable service. This guide highlights the top 25 health insurance companies in the U.S. based on market share and financial performance, providing valuable insights to help you make informed decisions. Additionally, it explores alternative health benefit strategies, such as HRAs and stipends, which can be especially advantageous for small businesses seeking flexible and cost-effective solutions.

Offering health benefits is not only a strategic move for attracting and retaining talent but also for fostering a healthy, productive workforce. Whether you’re an employer aiming to provide comprehensive coverage or an individual exploring your insurance options, understanding the leading insurers and innovative benefit structures is essential. This overview discusses the dominant players in the industry, how much revenue they generate through premiums, and why emerging benefit models are gaining popularity.

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What Is Traditional Group Health Insurance?

When comparing health insurers, many organizations initially consider group health plans. These plans involve employers selecting a medical coverage package to provide to employees and their dependents at reduced rates. Typically, insurers require a minimum participation rate—often around 70%—for a group to qualify. If the threshold isn’t met, the organization may not be eligible for coverage through that insurer.

Insurance carriers offer various plan types, including:

• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Exclusive Provider Organizations (EPOs)
• Point-of-Service (POS) Plans

Employees enrolled in these plans usually pay a portion of the premium and are responsible for meeting an annual deductible before the insurance begins sharing costs for medical claims. Employers can purchase these policies directly from insurers, through licensed agents, or brokers. Small businesses in many states also have the option of buying plans via the Small Business Health Options (SHOP) marketplace, which may qualify them for the Small Business Health Care Tax Credit, reducing overall costs.

The cost of group health insurance varies depending on numerous factors, but generally, premiums tend to increase each year. According to the Kaiser Family Foundation (KFF), the average annual premium in 2024 was approximately $8,951 for self-only coverage and $25,572 for family coverage. Employers contributed an average of $7,584 toward self-only plans and $19,276 toward family plans. While group coverage remains a preferred choice for many, the high costs can be prohibitive for smaller enterprises.

Alternatively, individuals can purchase their own insurance policies directly through the Health Insurance Marketplace, or through state exchanges. Many of the same carriers offer these plans, providing flexibility without the administrative burden of traditional group plans. Employers can also offer stand-alone HRAs to reimburse employees for health expenses, offering a more adaptable benefits approach.

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Top 25 U.S. Health Insurance Companies by Market Share

Knowing which insurers dominate the market can guide both employers and individuals toward reputable, comprehensive coverage options. Market share indicates a company’s footprint and financial stability within the industry.

Based on data from the National Association of Insurance Commissioners (NAIC), the following are the top 25 insurers ranked by their market share percentages in 2023:

| Rank | Company | Market Share 2022 | Market Share 2023 |

|——-|———–|———————|———————|

| 1 | UnitedHealth Group (including UnitedHealthcare) | 15.34% | 16.37% |

| 2 | Elevance Health Inc. (formerly Anthem) | 7.16% | 7.08% |

| 3 | Centene Corporation | 6.68% | 6.76% |

| 4 | Humana | 6.03% | 6.61% |

| 5 | CVS Health (including Aetna) | 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% |

While market share offers insights into a company’s size and financial robustness, it doesn’t necessarily reflect the quality of care or customer satisfaction. Larger market shares usually indicate a broader provider network and greater financial stability, making these insurers reliable options for many consumers.

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Premium Revenue of Leading Insurers

In 2023, U.S. health insurers collectively earned approximately $1.08 trillion in net premiums, marking an 8% increase from 2022. This growth demonstrates ongoing demand for health coverage amid rising healthcare costs and inflation.

UnitedHealth Group, the industry leader, generated about $248 billion in premiums, underscoring its dominant position. Conversely, smaller players like Health Net Community Solutions earned around $8.35 billion. Industry analysts anticipate continued increases in healthcare utilization, driven by aging populations and higher-risk patients, reinforcing the importance of offering comprehensive benefits to attract and retain employees.

Below is a snapshot of the top insurers by their premium collections in 2023:

| Rank | Insurer | Premiums in 2023 (NAIC) |

|——-|————–|—————————-|

| 1 | UnitedHealth Group | $248,763,012,672 |

| 2 | Elevance Health Inc. | $107,650,449,800 |

| 3 | Centene Corporation | $102,711,951,802 |

| 4 | Humana | $100,521,046,979 |

| 5 | CVS Health | $97,614,161,371 |

| 6 | Kaiser Foundation | $94,124,863,877 |

| 7 | HCSC | $55,500,353,206 |

| 8 | Cigna | $39,580,464,561 |

| 9 | Molina Healthcare | $30,942,107,198 |

| 10 | GuideWell | $28,978,443,339 |

Offering diverse coverage options, including innovative models like medical imaging advancements and flexible reimbursement plans, can help attract a broader range of employees and consumers.

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Benefits of HRAs and Stipends for Small Businesses

With premium costs continually rising, small and medium-sized companies often find traditional group plans financially challenging. Meeting minimum participation requirements and managing administrative burdens can deter small employers from offering valuable health benefits. Fortunately, alternative strategies like HRAs (Health Reimbursement Arrangements) and stipends provide more flexible, budget-friendly options.

An HRA allows employers to reimburse employees, tax-free, for qualified medical expenses or insurance premiums. These plans enable customization, allowing businesses to set monthly allowances, which employees can use for various healthcare costs. For example, the individual coverage HRA (ICHRA) permits companies of all sizes to reimburse employees for their private health insurance premiums without the need for group coverage.

Similarly, the qualified small employer HRA (QSEHRA) is tailored for smaller firms with fewer than 50 employees, offering a maximum allowance that employees can allocate toward their preferred insurance plans and out-of-pocket expenses. These arrangements are particularly advantageous for startups and small businesses aiming to provide meaningful benefits without the administrative complexity of traditional plans.

Another option is the integrated HRA, which complements existing group coverage, such as high-deductible health plans. Employers can reimburse employees for deductibles, coinsurance, and other out-of-pocket expenses, giving staff greater flexibility.

Lastly, taxable stipends are straightforward to implement and offer employees a fixed amount of money to cover medical costs, including supplemental dental and vision plans. Although stipends are considered taxable wages, they provide employees with the freedom to allocate funds as they see fit. However, employers should note that stipends alone do not fulfill employer mandate requirements under the Affordable Care Act (ACA).

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How PeopleKeep Simplifies Employee Benefit Management

Managing HRAs and stipends can seem complex, especially for small teams. Fortunately, PeopleKeep offers intuitive software solutions that streamline benefit administration. Their platform automates tasks such as processing reimbursements, maintaining compliance, and managing plan details, reducing administrative burdens. With expert support and user-friendly tools, small businesses can confidently implement and manage personalized health benefits, enhancing employee satisfaction and retention.

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Final Thoughts

While traditional health insurance companies provide essential coverage options, exploring flexible benefit solutions like HRAs and stipends can be advantageous, especially for smaller organizations. These alternatives allow employees to tailor their healthcare choices while enabling employers to control costs and administrative complexity. As healthcare continues to evolve, staying informed about the latest industry developments, including advancements in medical imaging and emerging benefit models, will help you craft a competitive and compliant benefits package.

If you’re considering implementing an HRA or stipend program, expert guidance can make the process smoother. Reach out to providers like PeopleKeep for support in designing benefits that meet your organizational needs and support your employees’ health and well-being.