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
| Rank | Definitive ID | Payor name | State | Total incurred claims | Covered lives | Explore dataset |
|---|---|---|---|---|---|---|
| 1 | 583130 | Kaiser Permanente Health Plans | CA | $48,190,589,886 | 9,257,115 | Explore |
| 2 | 583151 | UnitedHealthcare (AKA UnitedHealth Group) | MN | $31,197,766,592 | 7,266,859 | Explore |
| 3 | 575957 | Elevance Health (FKA Anthem Blue Cross & Blue Shield) | IN | $30,985,209,365 | 5,837,538 | Explore |
| 4 | 853221 | Health Care Service Corporation Group | IL | $27,089,269,607 | 5,012,197 | Explore |
| 5 | 552479 | Guidewell Mutual Holding Group (FKA Blue Cross and Blue Shield of Florida) | FL | $13,889,381,085 | 2,375,334 | Explore |
| 6 | 575895 | Centene Corporation | MO | $13,418,778,596 | 2,644,427 | Explore |
| 7 | 552477 | Blue Shield of California | CA | $12,195,926,108 | 2,397,370 | Explore |
| 8 | 552393 | Aetna | CT | $11,884,017,306 | 2,436,521 | Explore |
| 9 | 552436 | Cigna | CT | $11,628,634,678 | 2,203,802 | Explore |
| 10 | 575917 | CareFirst BlueCross BlueShield | MD | $7,195,025,341 | 1,356,715 | Explore |
| 11 | 552472 | BlueCross BlueShield of Michigan Group | MI | $6,395,661,082 | 1,446,414 | Explore |
| 12 | 552480 | Highmark | PA | $6,061,050,336 | 1,200,581 | Explore |
| 13 | 1041823 | BlueCross Blue Shield of NC Group | NC | $6,031,728,568 | 1,011,974 | Explore |
| 14 | 575753 | BlueCross BlueShield of Massachusetts Group | MA | $5,218,911,620 | 880,201 | Explore |
| 15 | 553215 | Horizon Blue Cross Blue Shield of New Jersey | NJ | $5,096,699,541 | 800,870 | Explore |
| 16 | 1057866 | BlueCross BlueShield of Alabama Group | AL | $4,640,722,164 | 907,023 | Explore |
| 17 | 552481 | Humana Group | KY | $4,239,355,565 | 777,097 | Explore |
| 18 | 575058 | Independence Blue Cross Group | PA | $3,767,306,513 | 811,687 | Explore |
| 19 | 583128 | EmblemHealth | NY | $3,379,255,409 | 500,117 | Explore |
| 20 | 583141 | Regence | OR | $3,330,774,479 | 747,541 | Explore |
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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