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 NameDefinitive IDFirm TypeStateTotal Incurred ClaimsTotal Direct Premium EarnedCovered LivesExplore This Dataset
1Kaiser Permanente Health Plans583130PayorCA$44,793,463,188$50,967,482,0459,315,959Explore This Profile
2UnitedHealthcare583151PayorMN$33,646,659,210$42,407,097,3818,411,196Explore This Profile
3Anthem Blue Cross & Blue Shield575957PayorIN$30,828,168,717$37,912,630,1265,998,133Explore This Profile
4Health Care Service Corporation Group853221PayorIL$23,344,341,956$28,791,218,8334,640,496Explore This Profile
5Aetna552393PayorCT$14,421,172,501$17,261,224,0062,937,201Explore This Profile
6Florida Blue552479PayorFL$12,650,947,868$16,413,720,3892,397,800Explore This Profile
7Blue Shield of California552477PayorCA$11,543,656,846$14,396,749,9392,554,513Explore This Profile
8Cigna552436PayorCT$9,612,601,243$11,888,734,8732,018,658Explore This Profile
9Centene Corporation575895PayorMO$9,323,269,672$13,078,998,5452,007,398Explore This Profile
10CareFirst BlueCross BlueShield575917PayorMD$7,021,843,816$8,569,792,7771,352,504Explore This Profile
11BlueCross BlueShield of Michigan Group552472PayorMI$6,361,872,944$8,021,179,2251,472,320Explore This Profile
12BlueCross BlueShield of North Carolina552474PayorNC$5,729,711,943$7,594,149,939999,377Explore This Profile
13BlueCross BlueShield of Massachusetts Group575753PayorMA$5,535,104,329$6,268,845,492991,330Explore This Profile
14Horizon Blue Cross Blue Shield of New Jersey553215PayorNJ$5,292,994,621$6,464,122,800866,131Explore This Profile
15Highmark552480PayorPA$5,288,279,430$6,358,909,4011,055,488Explore This Profile
16Humana Group552481PayorKY$4,531,650,263$5,532,888,9391,004,987Explore This Profile
17BlueCross BlueShield of Alabama575911PayorAL$4,177,378,804$4,954,535,997894,405Explore This Profile
18Independence Blue Cross Group575058PayorPA$3,981,845,684$5,469,323,862841,593Explore This Profile
19EmblemHealth583128PayorNY$3,482,799,310$4,171,848,142578,625Explore This Profile
20Regence583141PayorOR$3,168,590,921$3,879,547,646740,762Explore 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.

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