Top 5 Insurers With The Highest Market Shares In The Most States

Payers that hold the highest market shares nationwide may not have the greatest predominance in a single state, a HealthCareInsider analysis found.

UnitedHealth Group is considered the company with the most market share, with a total of 49.5 million members across all lines of business. However, the HealthCareInsider analysis revealed that UnitedHealth Group held the top market share in only one state. The payer had 61 percent of the market share in Nevada.

Instead of UnitedHealth Group dominating every state, Centene was the payer that had the greatest prevalence by state. The payer had the top market share in the most number of states, leading in five states. In these states, Centene held a market share of anywhere from 37 percent to 62 percent.

That being said, if Blue Cross Blue Shield companies were viewed together as opposed to being calculated as individual entities, Blue Cross Blue Shield would dominate the group health insurance market. The company would span 17 states.

As it is, even as individual entities some Blue Cross Blue Shield companies ranked in the top ten with the highest number of states in which they held the highest market share.

In fact, one Blue Cross Blue Shield company—Health Care Services Corporation—had the second-highest number of states in which it held top market share. The payer holds 95 percent of the market share in Oklahoma and 80 percent of the market share in the state of Illinois. Its lowest market share was 39 percent in Montana and Texas.

Anthem took third place with the top market share in Kentucky, New Hampshire, and Virginia.

Aside from Health Care Services Corporation, CareFirst and Highmark were two Blue Cross Blue Shield companies that also held dominant positions in certain state markets. CareFirst had 68 percent of the market share in the state of Maryland and 84 percent of the market share in the District of Columbia.

Highmark had 100 percent of the market share in the state of Delaware. It also held 68 percent of the market share in West Virginia.

Both CareFirst and Highmark recently hit headlines by launching a new product that targeted labor unions. The service is called “Union Blue” and will be available to labor union members in the 2022 plan year.

UnitedHealth Group had the highest market share nationwide in 2020, according to both the National Association of Insurance Commissioners (NAIC) as referenced in the HealthCareInsider analysis and according to the American Medical Association’s report from earlier in 2021.

NAIC reported that the payer had 14 percent of the national market share based on its premium revenue, followed by Kaiser Permanente with eight percent, Anthem and Centene with six percent, and Humana with five percent. 

The American Medical Association report had different figures, with UnitedHealth Group still first but followed by Anthem, Aetna, Cigna, and Kaiser in that order.

The HealthCareInsider analysis noted that these payers may have held the largest market share nationwide but some did not have marketplace predominance in any states. Humana and Cigna, which are both among the top ten largest health insurance companies nationally, did not hold the top market share in a single state.

In 2020, Centene, the company with the largest number of states in which it holds the highest market share, finalized its deal to merge with Wellcare. That deal has continued to have impacts on the payer’s size, growth, and structure.

In 2021, Wellcare—now a wholly-owned subsidiary of Centene—announced that all of Centene’s Medicare products would now be offered under the Wellcare brand. Since their 2020 merger, the combined company has reached across 33 states.