Top healthcare insurance companies by incurred claims

Hospital revenue sources break down 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 67.5% in 2023, reflecting market dynamics like private insurance companies compensating hospitals at a higher rate than government programs and increasing Medicare Advantage enrollment.

How are the top-performing health insurance companies measured?

Some of the key metrics related to the performance of health insurance companies include:

• Annual revenue
• Member enrollment or covered lives
• Claims volumes and total values
• Premiums earned

Different health insurance companies may be considered top performers depending on the metric considered. For example, UnitedHealthcare had the fourth-highest direct premium earned and total incurred claims in 2023, but the second-highest total covered lives.

The Definitive Healthcare ConnectedCareView product tracks key metrics on over 1,200 payor and payor subsidiary organizations. Financial data for health insurance payors is sourced from the Centers of Medicare and Medicaid Services’ (CMS) Consumer Information and Oversight (CCIIO) Medical Loss Ratio reports for calendar year 2023, the most recent full year of data available at the time of publishing.

What are total incurred claims?

The total incurred claims metric in ConnectedCareView represents direct claims paid to or received by physicians and other clinical providers, including under capitation contracts with those providers, whose services are covered by the policy for clinical services or supplies covered by the policy.

The following list highlights the top 20 payors (excluding payor subsidiaries) based on total incurred claims for calendar year 2023, the most recent full year of data available.