Top 5 Largest Health Insurance Payers in the United States

1. UNITEDHEALTH GROUP

2022 Net Revenues: $324.2 billion

Enrollment: 51 million

Rev Growth (year-over-year):  +12.0 percent

UnitedHealth Group incorporates a network of almost 1.7 million physicians and 6,400 hospitals and sites of care. Optum, its integrated information and technology platform, is in use in 9 out of 10 hospitals in the US, serving 129 million individuals and four out of five health plans. This includes Optum Rx, the pharmacy care service, which works with CMS and private groups in over 67,000 pharmacies across the nation.

US News listed UnitedHealth Group as the top health care stock to buy in June 2023.

2. ELEVANCE HEALTH (FORMERLY ANTHEM)

2022 Net Revenues: $156 billion

Enrollment: 47.5 million

Rev Growth (year-over-year):  +13.7 percent

Elevance Health—formerly known as Anthem before it rebranded in June 2022—has maintained its presence as the nation’s second-largest payer. Holding onto some of its former branding, Anthem Blue Cross and Anthem Blue Cross and Blue Shield are the payer’s brands that offer medical benefits.

CarelonRx is the payer’s pharmacy benefit manager which serves one in three people across all 50 states. The company has invested in digital health through its Sydney Health mobile app.

3. CENTENE

2022 Net Revenues: $144.5 billion

Enrollment: 27 million

Revenue growth: +15 percent

Centene’s membership primarily draws from government-sponsored lines of business—Medicaid, Medicare, dual eligibles, and TRICARE. In 2022, the payer divested itself of Magellan Rx, its pharmacy benefits manager, and PANTHERx Rare, its pharmacy.

Having a largely government-sponsored portfolio increased the payer’s revenue and enrollment growth in 2022 because of the public health emergency’s continuous enrollment requirement.

However, it could also factor into the company’s enrollment in 2023. Centene executives have anticipated losing 2.2 million new Medicaid enrollees between 2023 and mid-2024 and adding 200,000 to 300,000 enrollees on their ACA marketplace plans.

4. AETNA

2022 Net Revenues: $322.5 billion

Enrollment: 24.4 million

Revenue growth: +10.4 percent

Aetna became a CVS Health product in 2018, overcoming legal hurdles. The payer offers Medicare, Medicaid, Medicare Advantage, ACA, individual, and employer-sponsored health plans.

Beyond its health insurance plans, CVS Health leverages its retail segment to sell health and wellness products and promote access to care through its MinuteClinics health clinics. It also provides pharmacy services.

Formed in 1853, this Hartford, Connecticut-based insurer has always had an eye for growth and expanding markets. After withdrawing from many state ACA markets in 2015, the payer re-entered the space on January 1, 2022 and expanded into 12 states the following year.

Its parent company, CVS Health, also sealed deals with Signify Health and Oak Street Health in 2023.

5. CIGNA

2022 Net Revenues: $180.5 billion

Enrollment: 18.0 million

Revenue growth: +24 percent

Formed by a merger in 1982 between the INA Corporation and Connecticut General Corporation, this global health service company has found success while incorporating dental and Medicare verticals, offering Medicare prescription plans in all 50 states.

“Last year was a pivotal year of performance and growth for our company as individuals and employers around the world counted on Cigna Healthcare in a dynamic time, and Evernorth further expanded its health services reach and impact,” David M. Cordani, chairman and chief executive officer of Cigna, said in the 2022 full year results press release.

“We are well positioned to continue innovating and growing as we work to improve the health and vitality of all those we serve.”