Healthcare Insights

Top 20 largest healthcare insurance companies

Hospital revenue sources breakdown into a payor mix of private insurance companies and government insurance programs like Medicare and Medicaid.

The percentage of the total payor mix from private/self-pay revenue reached 68% in 2020, reflecting market dynamics like private insurance companies compensating hospitals at a higher rate than government programs and increasing Medicare Advantage enrollment.

The Definitive Healthcare ConnectedCareView product tracks key metrics on over 1,200 payor and payor subsidiary organizations. The following list highlights the largest 20 payors (excluding payor subsidiaries) based on total incurred claims for calendar year 2020, the most recent full year of data available.

Largest healthcare insurance companies by total incurred claims

RankDefinitive IDPayor nameStateTotal incurred claimsCovered livesExplore dataset
1583130Kaiser Permanente Health PlansCA$48,190,589,886 9,257,115Explore
2583151UnitedHealthcare (AKA UnitedHealth Group)MN$31,197,766,592 7,266,859Explore
3575957Elevance Health (FKA Anthem Blue Cross & Blue Shield)IN$30,985,209,365 5,837,538Explore
4853221Health Care Service Corporation GroupIL$27,089,269,607 5,012,197Explore
5552479Guidewell Mutual Holding Group (FKA Blue Cross and Blue Shield of Florida)FL$13,889,381,085 2,375,334Explore
6575895Centene CorporationMO$13,418,778,596 2,644,427Explore
7552477Blue Shield of CaliforniaCA$12,195,926,108 2,397,370Explore
8552393AetnaCT$11,884,017,306 2,436,521Explore
9552436CignaCT$11,628,634,678 2,203,802Explore
10575917CareFirst BlueCross BlueShieldMD$7,195,025,341 1,356,715Explore
11552472BlueCross BlueShield of Michigan GroupMI$6,395,661,082 1,446,414Explore
12552480HighmarkPA$6,061,050,336 1,200,581Explore
131041823BlueCross Blue Shield of NC GroupNC$6,031,728,568 1,011,974Explore
14575753BlueCross BlueShield of Massachusetts GroupMA$5,218,911,620 880,201Explore
15553215Horizon Blue Cross Blue Shield of New JerseyNJ$5,096,699,541 800,870Explore
161057866BlueCross BlueShield of Alabama GroupAL$4,640,722,164 907,023Explore
17552481Humana GroupKY$4,239,355,565 777,097Explore
18575058Independence Blue Cross GroupPA$3,767,306,513 811,687Explore
19583128EmblemHealthNY$3,379,255,409 500,117Explore
20583141RegenceOR$3,330,774,479 747,541Explore

Fig 1 Data is from the Definitive Healthcare ConnectedCareView product and sourced from proprietary research and the CMS Consumer Information and Oversight (CCIIO) Medical Loss Ratio reports. The most recent data is from calendar year 2020. Accessed February 2023.

What are the largest healthcare payors?

Kaiser Permanente Health Plans had the highest incurred claims at over $48.2 billion — approximately 19% of the claims represented on this list. Along with ranking first in incurred claims, Kaiser Permanente Health Plans also had the highest total covered lives at just over 9 million people, making it the largest medical insurance company in the U.S.

Kaiser Permanente is one of the largest healthcare systems in the U.S. and predominately based in the western U.S. with many hospitals in California. The state’s high population likely contributes to the high patient count for the health plans. Kaiser Permanente operates a unique model in which they offer patient care services in addition to health insurance coverage.

UnitedHealthcare had nearly $32 billion in incurred claims, followed closely by Elevance Health (formerly known as Anthem Blue Cross & Blue Shield), with about $31 billion in total claims. These two health plans also have the second and third highest total covered lives, respectively.

In 2020, the list of the top 20 largest healthcare payor organizations accounted for over $255.8 billion in incurred claims and covered nearly 50 million patient lives.

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