Top 5 Largest Health Insurance Payers in the United States

Deciding to provide or enroll in health insurance is a major step for both employers and individuals alike. It can be daunting, particularly for small businesses lacking dedicated HR or benefits support. However, investing time and effort into establishing a formal health benefit plan is highly beneficial.

Offering an employer-sponsored health insurance plan comes with numerous advantages. These include enhancing employee retention and attraction, distinguishing your business, and fostering a content and healthy workforce.


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UnitedHealth Group, Inc. is a prominent provider of healthcare coverage, software solutions, and consultancy services. The company operates through several key segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx.

The UnitedHealthcare segment leverages Optum’s resources to facilitate patient care coordination, enhance the affordability of medical services, analyze cost patterns, manage pharmacy benefits, improve collaboration with healthcare providers, and streamline the consumer experience.

OptumHealth delivers a wide range of health and wellness services, catering to various stakeholders in the healthcare ecosystem, including payers, providers, employers, government entities, life sciences firms, and consumers.

Focused on data, analytics, and technology, the OptumInsight segment provides valuable insights and solutions to key players in the healthcare industry.Lastly, the OptumRx segment specializes in pharmacy care services.Founded by Richard T. Burke in January 1977, the company is headquartered in Minnetonka, MN.


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Formerly known as Anthem before its rebranding in June 2022, Elevance Health continues to stand as the nation’s second-largest payer. Retaining elements of its previous branding, Anthem Blue Cross and Anthem Blue Cross and Blue Shield remain as the payer’s brands providing medical benefits.

CarelonRx, the company’s pharmacy benefit manager, extends its services to one in three individuals across all 50 states. Additionally, Elevance Health has ventured into digital health with its Sydney Health mobile app.


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

The emphasis on government-sponsored plans fueled revenue and enrollment growth in 2022 due to continuous enrollment requirements amid the public health emergency. However, this dynamic may affect enrollment in 2023. Centene executives anticipate a loss of 2.2 million new Medicaid enrollees between 2023 and mid-2024 while projecting an increase of 200,000 to 300,000 enrollees in their ACA marketplace plans.


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In 2018, Aetna became part of CVS Health after overcoming legal challenges. The payer offers a range of health plans including Medicare, Medicaid, Medicare Advantage, ACA, individual, and employer-sponsored plans. In addition to health insurance, CVS Health utilizes its retail segment to market health and wellness products and facilitate access to care through MinuteClinics health clinics.

 It also offers pharmacy services. Established in 1853 and headquartered in Hartford, Connecticut, this insurer has consistently pursued growth and market expansion. After scaling back its presence in many state ACA markets in 2015, the payer re-entered the space on January 1, 2022, and expanded into 12 states the following year.


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This global health service company, formed through a merger in 1982 between the INA Corporation and Connecticut General Corporation, has achieved notable success. It has diversified its offerings by incorporating dental and Medicare verticals, providing Medicare prescription plans across all 50 states.

In the 2022 full-year results press release, David M. Cordani, chairman and chief executive officer of Cigna, highlighted the company’s performance and growth amidst a dynamic environment. He emphasized the pivotal role Cigna Healthcare played for individuals and employers worldwide, while also noting the expansion and impact of Evernorth’s health services. Cordani expressed confidence in the company’s ability to innovate and grow further, aiming to enhance the health and well-being of all its beneficiaries.

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