Revealed 10 Largest Health Insurance Providers In The US

Read more: AM Best on the state of the health insurance industry

How does health insurance work?

Health insurance is a policy designed to help offset the cost of medical care by paying a portion of medical and hospital bills. According to the State Health Insurance Exchange HeatlhCare.gov, this type of coverage comes in a variety of forms designed to meet the different needs of policyholders.

"Some types of plans limit provider choice or encourage people to seek care through the plan's network of doctors, hospitals, pharmacies, and other healthcare providers," the website explained. "Others pay a larger share of the costs of providers outside the plan's network."

According to HealthCare.gov, the types of policies currently available on the market include:

Exclusive Provider Organization (EPO) - This is a managed care plan where benefits are only covered if the doctor, specialist or hospital is part of the plan's network, except in emergencies.

Health Maintenance Organization (HMO) - This type of health insurance plan often limits coverage to care provided by physicians who are employed or contracted by the HMO. Policies generally do not cover offline support except in an emergency. Plans may also require the policyholder to live or work in their service area in order to qualify for coverage. HMOs generally provide integrated care and focus on prevention and wellness.

Point of Service (POS): With this type of policy, policyholders pay less when accessing doctors, hospitals, and other healthcare professionals who are part of the plan's network. POS coverage also requires the policyholder to get a referral from their primary care doctor so they can see a specialist.

Preferred Provider Organization (PPO) - This health plan allows members to pay less for health care if they choose to receive care from providers in the plan's network. However, you can also access offline doctors, hospitals, and providers without a referral and at an additional cost.

Read more: Millennials think health insurance is too expensive: Survey

Health insurance policies are also offered in four categories based on the distribution of costs between the insured and the insurer. These are bronze, silver, gold and platinum. However, HealthCare.gov noted that the category "has nothing to do with [the] quality of care."

Here is the estimated breakdown for each category.

Category

health insurer

service provider

bronze

60%

40%

Silver

70%

30%

requested

80%

twenty%

platinum

90%

ten%

Source: HealthCare.gov

Bronze plans have the lowest monthly premiums, but policyholders must pay higher direct costs before the policy takes effect. The reverse is true for Platinum coverage, which has the most expensive rates but the lowest deductibles.

Read more: The best health insurance providers for the US self-employed

What does health insurance cover?

One of the changes introduced by the Affordable Care Act (ACA) in the national health care system is the standardization of insurance benefits. Previously, the benefits offered by insurers varied considerably from policy to policy. Currently, US health insurance plans must cover a list of 10 “essential health benefits” including:

Ambulatory care

emergency services

recovery

Pregnancy, labor and newborn care

Mental health services and substance use disorders, including behavioral therapy treatments

prescribed medication

Rehabilitation and rehabilitation services and equipment

laboratory services

Prevention and wellness services and chronic disease treatment

Pediatric services including vision and oral hygiene

Adult dental and vision insurance is not considered an essential benefit, but is available as an optional top-up benefit alongside medical management programs.

Birth control and breastfeeding coverage are also mandatory benefits.

READ ALSO: Former NBA Player Pleads Guilty In Health Insurance Fraud Case

How much does health insurance cost?

According to HealthCare.gov, insurance companies can only consider five factors when setting premiums under the health care law.

Age: Premiums for older people can be up to three times higher than those for younger people.

Location: Differences in competition, state and local regulations, and cost of living also affect health insurance rates.

Smoking: Insurers can charge smokers up to 50% more than non-smokers.

Individual vs. Family Membership: Insurers may also charge more for a plan that also covers spouse and dependents.

Plan Category: The different plan categories (Bronze, Silver, Gold, and Platinum) also affect the price.

The government website warned that states can limit the impact of these factors on insurance rates, but prohibited them from using medical history and gender to calculate premiums.

“Insurance companies cannot charge women and men different rates for the same plan,” HealthCare.gov explained. "You can't even take into account your current health or medical history. All health insurance plans must cover treatment for pre-existing conditions from the day coverage begins."

What are the major health insurance companies in the United States?

The top 10 health insurance companies in the United States underwrite nearly 57% of all policies in the market, with the top 5 accounting for 41%, according to the latest figures from the National Association of Insurance Commissioners (NAIC).

These providers offer basic health insurance products for individuals and businesses, as well as other services that may include Medicaid and Medicare policies, long-term care insurance, dental insurance, and vision care.

It is the nation's largest health insurance provider by direct premiums written, according to NAIC data.

1. UnitedHealth Group

Headquarters: Minnetonka, Minnesota Directly Earned Rewards: $195.4 Billion Market Share: 14.47% Membership: 49.5 Million States Available: Nationwide

As a diversified health and wellness company, UnitedHealth Group's core competencies are clinical experience, cutting-edge technology, and health data and information.

UnitedHealth serves clients and consumers in the United States and more than 130 countries through two distinct platforms. UnitedHealthcare, which has a network of more than 1.3 million doctors and healthcare professionals and 6,500 hospitals, provides healthcare and services, while Optum provides healthcare information and services technology-based. The group invests over $4 billion in technology and innovation and processes approximately 1.1 trillion transactions annually.

2. Kaiser Foundation

Headquarters: San Francisco, CA Direct Written Premiums: $107.8 billion Market Share: 7.98% Membership: 12.6 million Available States: All or parts of California, Colorado, Georgia, Hawaii, Maryland, Oregon , Virginia, Washington, Washington, D.C.

Kaiser Foundation Health Plan, Inc. is a nonprofit health care organization. The organization offers budget-based plans that can cover allergy, audiology, cardiology, dermatology, oncology, palliative care, laboratory, nephrology, occupational therapy, pain, pediatric rehabilitation and pharmacy. The insurer's policies have lower premiums and no deductibles and include prescription drugs.

3. Elevance Health (formerly Anthem)

Headquarters: Indianapolis, Indiana Direct premiums: $93.8 billion Market share: 6.95% Membership: 32+ million states available: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada , New Hampshire New York, Ohio, Virginia , Wisconsin

Anthem changed its name to Elevance Health in June 2022. Health insurance offers medical, pharmaceutical, dental, behavioral, long-term care and disability plans through affiliates such as Anthem Blue Cross and Blue Shield , Empire BlueCross BlueShield in New York, Anthem Blue Cross in California, Wellpoint and Carelon. Elevance Health has a network of 1.7 million doctors and hospitals in 14 states and is the largest for-profit healthcare company in the Blue Cross Blue Shield Association.

4. Rye

Location: S. Louis, Missouri Direct written premiums: $82.4 billion Market share: 6.10% Membership: over 26 million states Available: 29 states including California, Florida, New York and Texas, four of the largest Medicaid states

Centene Corporation, a Fortune 500 company, is a diversified multinational health care company that provides a portfolio of services to government-sponsored health programs, with a focus on the uninsured and underinsured. It is currently the largest Medicaid managed care organization in the country.

Centene operates local health insurance companies and offers a range of health insurance products. It also collaborates with other healthcare and business groups to provide specialist services ranging from behavioral health, dentistry, life and health and pharmaceutical service management to care management software, corrections, home health services, managed vision, specialty pharmacy and telemedicine services. .

5. human being

Headquarters: Louisville, Kentucky Direct premiums written: $79.6 billion Market share: 5.90% Subscription: 20+ million states Available: Nationwide

Humana's Cultural Foundation is dedicated to helping members achieve their best health by providing personalized, streamlined, and holistic health experiences. Recognizing that the health needs of every individual, family and community are changing, Humana creates innovative solutions and resources to help people live healthier lives on their own terms, when and where they need it.

6. CVS Health

Headquarters: Woonsocket, Rhode Island Direct Earned Rewards: $74.3 Billion Market Share: 5.51% Membership: 23+ Million (Medical Benefits) Available States: Nationwide

CVS Health is an innovative healthcare company dedicated to helping people on their journey to better health. It has over 9,900 outlets, nearly 1,100 mobile medical clinics, a pharmacy benefits manager with approximately 100 million plan members, a diversified health benefits company with over 23 million medical members, and a business of pharmacy. specialty pharmaceutical care with more than one million patients per year, expanded specialty pharmacy services, and an independent plan for Medicare Part D prescription drugs.

7.HCSC

Headquarters: Chicago, Illinois Direct premiums: $46.5 billion Market share: 3.44% Membership: approximately 17 million Available states: Illinois, Montana, New Mexico, Oklahoma, Texas

Health Care Service Corporation (HCSC), a statutory reserve mutual, is the largest consumer-owned health insurance company in the United States. The company offers a wide range of life and health insurance products and related services through its subsidiaries and affiliates, including Dearborn Group, Dental Network of America, HCSC Insurance Service Company, Medecision, Availity, Prime Therapeutics and TriWest Healthcare Alliance.

8. Zigna

Headquarters: Bloomfield, Connecticut Direct premiums: $34.1 billion Market share: 2.53% Membership: 17+ million states available: Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee , Utah, Virginia

Cigna's insurance plans and products include individual and family health plans, dental plans, Medicare plans, Medicare supplemental plans, other supplemental plans and international health plans.

9. Molina Health

Location: Long Beach, California Direct premiums: $26.5 billion. Market share: 1.97% Membership: approximately four million

Available states: Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Ohio, Nevada, New Mexico, New York, South Carolina, Texas, Utah, Virginia, Washington, Wisconsin

Molina Healthcare, a Fortune 500 company, focuses exclusively on government-sponsored healthcare programs for qualified individuals and families. The company works with state governments and acts as a health plan, providing a wide range of quality health services for individuals and families. It also offers a Medicare product and has been selected in multiple states to participate in two demonstration projects to manage care for those eligible for Medicaid and Medicare.

10. Independence Health Group

Headquarters: Philadelphia, PA Direct premiums: $22.8 billion Market share: 1.69% Membership: Over eight million states Available: Southeastern Pennsylvania, 27 states through affiliates

Independence Health Group, along with its subsidiaries, serves customers in 27 states and the District of Columbia. A quarter of the customer network is in southeastern Pennsylvania. The company serves a diverse group of employers, from mid-sized companies to national companies. Services offered by the insurer include corporate, Medicare and Medicaid coverage, drug benefit management, employee compensation, and third-party benefit management. The company is independently licensed by the Blue Cross and Blue Shield Association.

Operation London Bridge: how the Queen's funeral will take place | ABC news