The Biggest Health Insurance Giants in America

Ranked: The Largest Health Insurers in America

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Over the past decade, the American health insurance industry has seen a wave of consolidation, contributing to higher premiums and increased market concentration.

Today, four of the top 20 companies in the Fortune 500 are health insurers, with combined revenues of nearly $1.1 trillion in 2023. Going further, the collective revenues of the nation’s six largest for-profit health insurers accounted for almost 30% of U.S. health spending last year. By comparison, they made up under 10% of the total in 2011.

This graphic shows America’s biggest health insurance companies by market share, based on data from the American Medical Association.

The Top 10 Biggest Health Insurance Companies in 2023

Here are the largest U.S. health insurers based on their share of total U.S. enrollments in 2023:

Rank	Company	Market Share in 2023
1	UnitedHealth Group	15%
2	Elevance Health	12%
3	CVS (Aetna)	12%
4	Cigna	11%
5	Health Care Service Corporation	7%
6	Kaiser	7%
7	Blue Cross Blue Shield of Florida	2%
8	Blue Cross Blue Shield of Michigan	2%
9	Centene	2%
10	Blue Shield of California	2%

Standing as the largest insurer in the country, UnitedHealthcare provides coverage to approximately 29 million Americans.

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UnitedHealth Group, parent company of UnitedHealthcare, is the fourth-largest firm in the U.S. by revenues behind Walmart, Amazon, and Apple. Its other major business unit, Optum, employs approximately 90,000 physicians, making it the largest employer of doctors in the country.

The recent shooting of UnitedHealthcare CEO Brian Thompson has thrown a spotlight on health insurance practices amid rising denial rates across the industry. In a 2023 survey from KFF, 18% of Americans said that they were refused care they expected would be covered over the last 12 months.

Following next in line is Elevance Health, which provides Blue Cross Blue Shield health insurance in 14 states. In December, the firm dropped plans to reduce anesthesia coverage over certain time limits following a backlash from medical professionals and the public.

Ranking in third is Aetna, a subsidiary of CVS Health. In 2017, CVS Health acquired Aetna for $69 billion, marking the biggest healthcare merger in U.S. history. Like CVS Health, major insurer Cigna acquired Express Scripts in 2018 for $54 billion.

Overall, the top four health insurance companies make up 50% of the national market share, highlighting the dominance of a few select players at a time of sky-high healthcare costs.

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