Healthcare Insights
Top Healthcare Payors by Incurred Claims
The following list highlights the top 20 payors by incurred claims, excluding payor subsidiaries. The included payors account for over $244.7 billion in incurred claims for 2018.
The payor with the highest incurred claims was Kaiser Permanente Health Plans with over $44.7 billion— 18.3% of the claims represented on the list. Along with ranking first in incurred claims, Kaiser Permante Health Plans also ranked first in Total Direct Premium Earned as well as Covered Lives, representing nearly one million more covered lives than the next appearing payor on the list, UnitedHealthcare.
Top 20 Payors by Total Incurred Claims
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| Payor Name | Definitive ID | Firm Type | State | Total Incurred Claims | Total Direct Premium Earned | Covered Lives | Explore This Dataset | |
| 1 | Kaiser Permanente Health Plans | 583130 | Payor | CA | $44,793,463,188 | $50,967,482,045 | 9,315,959 | Explore This Profile |
| 2 | UnitedHealthcare | 583151 | Payor | MN | $33,646,659,210 | $42,407,097,381 | 8,411,196 | Explore This Profile |
| 3 | Anthem Blue Cross & Blue Shield | 575957 | Payor | IN | $30,828,168,717 | $37,912,630,126 | 5,998,133 | Explore This Profile |
| 4 | Health Care Service Corporation Group | 853221 | Payor | IL | $23,344,341,956 | $28,791,218,833 | 4,640,496 | Explore This Profile |
| 5 | Aetna | 552393 | Payor | CT | $14,421,172,501 | $17,261,224,006 | 2,937,201 | Explore This Profile |
| 6 | Florida Blue | 552479 | Payor | FL | $12,650,947,868 | $16,413,720,389 | 2,397,800 | Explore This Profile |
| 7 | Blue Shield of California | 552477 | Payor | CA | $11,543,656,846 | $14,396,749,939 | 2,554,513 | Explore This Profile |
| 8 | Cigna | 552436 | Payor | CT | $9,612,601,243 | $11,888,734,873 | 2,018,658 | Explore This Profile |
| 9 | Centene Corporation | 575895 | Payor | MO | $9,323,269,672 | $13,078,998,545 | 2,007,398 | Explore This Profile |
| 10 | CareFirst BlueCross BlueShield | 575917 | Payor | MD | $7,021,843,816 | $8,569,792,777 | 1,352,504 | Explore This Profile |
| 11 | BlueCross BlueShield of Michigan Group | 552472 | Payor | MI | $6,361,872,944 | $8,021,179,225 | 1,472,320 | Explore This Profile |
| 12 | BlueCross BlueShield of North Carolina | 552474 | Payor | NC | $5,729,711,943 | $7,594,149,939 | 999,377 | Explore This Profile |
| 13 | BlueCross BlueShield of Massachusetts Group | 575753 | Payor | MA | $5,535,104,329 | $6,268,845,492 | 991,330 | Explore This Profile |
| 14 | Horizon Blue Cross Blue Shield of New Jersey | 553215 | Payor | NJ | $5,292,994,621 | $6,464,122,800 | 866,131 | Explore This Profile |
| 15 | Highmark | 552480 | Payor | PA | $5,288,279,430 | $6,358,909,401 | 1,055,488 | Explore This Profile |
| 16 | Humana Group | 552481 | Payor | KY | $4,531,650,263 | $5,532,888,939 | 1,004,987 | Explore This Profile |
| 17 | BlueCross BlueShield of Alabama | 575911 | Payor | AL | $4,177,378,804 | $4,954,535,997 | 894,405 | Explore This Profile |
| 18 | Independence Blue Cross Group | 575058 | Payor | PA | $3,981,845,684 | $5,469,323,862 | 841,593 | Explore This Profile |
| 19 | EmblemHealth | 583128 | Payor | NY | $3,482,799,310 | $4,171,848,142 | 578,625 | Explore This Profile |
| 20 | Regence | 583141 | Payor | OR | $3,168,590,921 | $3,879,547,646 | 740,762 | Explore This Profile |
Fig 1 Data from Definitive Healthcare's Payor Database; financial data is from CMS’ Consumer Information and Oversight (CCIIO) Medical Loss Ratio reports. The most recent data is from calendar year CY 2018.
