Top 10 Health Insurance Companies in the U.S.

Offering or enrolling in health insurance is a crucial choice for both businesses and employees. It may be difficult to know where to begin, particularly if you are a small firm with no HR staff or benefits expert to assist. However, putting in the time and study to establish a formal health benefit plan is definitely worth it.

Offering an employer-sponsored health insurance plan has various benefits, including helping to retain and recruit workers, differentiating your company, and contributing to a happy and healthy staff.

In this post, we'll look at the top 25 health insurance firms in the United States by market share, as well as alternative coverage choices for those looking to provide something more cost-effective and flexible than typical group health plans.

What is a typical definition of group health insurance?

Employers evaluating health insurance are most likely looking for a group health plan. So, before we go into the top health insurance companies in the United States, let's go over some of these plans.

Traditional group health insurance allows companies to choose a group medical plan for their firm and give coverage to their workers and qualified dependents at a discounted cost. Most insurers require companies to participate at a minimum of 70% in order to qualify for coverage.

Insurance companies provide a variety of plan types, including health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Before their insurer starts covering the cost of medical claims, a covered individual must pay their part of the premium as well as fulfill their yearly deductible.

Employers may purchase a group health insurance plan directly from an insurance company, licensed agent, or broker. Small companies may save on premiums by purchasing coverage via the Small Business Health Options (SHOP) marketplace and applying for the Small Business Health Care Tax Credit.

The cost of group health insurance varies, but premiums often rise annually. The average annual group health insurance premium in 2023 was $8,435 for self-only coverage and $23,968 for family coverage. Employers contributed $7,034 to their workers' individual plans and $17,393 to their family plans.

While their familiarity makes them popular among employers and workers, their high pricing may be too expensive for small enterprises.

Group coverage is not the only option for getting health insurance. Individuals may also buy their own health insurance coverage via the Health Insurance Marketplace or state exchanges. Many of the same group carriers provide individual health insurance coverage.

The top 10 health insurance firms in the United States, ranked by market share

If you're interested in selling a group health plan or an individual wanting to buy a plan on the exchanges, knowing which health insurance firms are trustworthy and provide a diverse variety of goods and medical providers is a great place to start looking for coverage.

The top ten health insurance firms in the United States are listed below in decreasing order of market share size, according to NAIC3.

Rank - Company - Market share in 2022

1 - UnitedHealth Group (including UnitedHealthcare) - 15.34%

2 - Elevance Health Inc. (formerly Anthem) - 7.16%

3 - Centene Corp - 6.68%

4 - Kaiser Foundation (Kaiser Permanente) - 6.18%

5 - Humana - 6.03%

6 - CVS Health (including Aetna Health) - 5.82%

7 - Health Care Services Corporation (HCSC) - 3.53%

8 - Cigna Health - 2.39%

9 - Molina Healthcare Inc - 1.99%

10 - GuideWell (including Florida Blue) - 1.84%

Market share size does not always correspond with the quality of a product or medical service, nor does it ensure that the firm will maintain its position throughout the year.

However, market share size reflects a company's competitiveness, financial health, and structural security, and insurers with greater market shares have higher direct written premiums. They may also have a larger network of providers.

How much do health insurance companies get in premiums?

According to the 2022 NAIC Health Insurance Report, U.S. health insurers earned almost $1 trillion in total net earned premiums. This represented an 11.4% rise in premium expenditure from US consumers in 2021, totaling $898 billion.

UnitedHealth, which leads our list, will write around $221 billion in premiums in 2022. In comparison, Blue Cross Blue Shield of Massachusetts owed $8.6 billion.

In the insurance business, national health specialists anticipate a rise in medical service demand due to inflation, deteriorating health conditions, and older and higher-risk individuals who require treatment.

Employers of all sizes may better attract and keep their workers by providing a variety of health insurance alternatives and other perks, such as wellness healthcare programs, to meet their employees' future medical needs.

Why HRAs and health stipends may be a better alternative for small firms

With escalating premiums, small and medium-sized enterprises may struggle to afford group medical insurance. However, there are additional health insurance solutions available for firms that cannot afford a typical benefit. One of these choices is a health-reimbursement agreement (HRA).

An HRA is a tax-free health benefit that allows you to compensate workers for out-of-pocket medical expenditures, such as health insurance premiums. An HRA allows you to create a monthly allowance that your workers may use to cover healthcare expenditures. When workers make an authorized purchase, you will refund them up to their allowance amount.

Because HRAs are adjustable, you can provide your workers with more flexibility and control over their health benefits at a reasonable cost.

We'll go over four different health benefits that may be appropriate for your company.

Qualified Small Employer HRA

A qualified small employer HRA (QSEHRA) is a health-care benefit designed for firms with less than 50 full-time equivalent workers (FTEs) that do not have a group plan.

With a QSEHRA, you select an allowance up to the yearly maximum contribution level that fits your budget, and your employees choose the insurance policy and out-of-pocket medical expenditures that are most appropriate for them and their families. As long as their insurance has minimum necessary coverage (MEC), employees get QSEHRA reimbursements tax-free.

Individuals may use their QSEHRA to get tax-free reimbursements for health insurance premiums and other out-of-pocket expenses such as mental health treatments, virtual care, and prescription medications. Our interactive expenditure calculator includes a comprehensive list of qualified HRA charges. When establishing your plan, you may select whether to compensate your workers for simply health insurance premiums or for premiums plus eligible out-of-pocket expenditures.

If you want to provide a QSEHRA, you must do so for at least all of your W-2 full-time workers. You may also supply it to your part-time staff. To meet federal requirements, however, you must provide them with the same allotment as your full-time workers.

Individual Coverage HRA

The individual coverage HRA (ICHRA), like the QSEHRA, is a health benefit that allows workers to receive tax-free reimbursement for individual health insurance premiums, as well as other medical services and costs. However, it is open to businesses of all sizes and has no maximum contribution limitations.

The ICHRA may be offered as a standalone benefit or as part of group health insurance coverage. However, you cannot offer your workers a choice between your group health plan and the ICHRA. You have to give one or the other.

The ICHRA is adjustable, allowing you to tailor it to your specific requirements by choosing various allowance levels for each of the 11 employee types. Employees may then opt in or out of the benefit before it starts, and they must demonstrate monthly that they still have private health care coverage to continue getting payments. The benefit is available only to people who have a qualifying individual health plan.

Finally, as long as your plan includes a reasonable amount for your workers, you may use an ICHRA to meet your employer's obligation. This makes an ICHRA an excellent option to standard group plans if you're an applicable large employer (ALE) wishing to save money while adhering to all Affordable Care Act (ACA) criteria.

Integrated HRA

The integrated HRA is ideal for those who wish to maintain their group health insurance or convert to a high-deductible health plan (HDHP) to save money on premiums.

The integrated HRA, also known as a group coverage HRA (GCHRA), is designed for companies of all sizes that have a group health insurance plan and wish to enhance their benefits. A GCHRA, like the QSEHRA and ICHRA, is a tax-free reimbursement option for companies looking to have more control over the expenses of their health benefit plans.

Only workers enrolled in your group health plan are eligible to participate. Additionally, a GCHRA cannot repay premiums. However, companies may pay workers for qualified out-of-pocket expenses that are not completely covered by their group health insurance plan, such as deductibles, coinsurance, and so on.

Integrated HRAs provide certain distinct advantages over other HRAs. Employers may specify an unlimited allowance amount, a predetermined deductible, and a cost-sharing amount for their workers. You may create your integrated HRA with seven employee classifications, just like with ICHRAs.

Offering an integrated HRA allows you to better serve your workers' individual healthcare requirements while still providing the group health plan of your choosing.

Health stipend

A health stipend is your final alternative benefit plan choice. The federal government regulates stipends less than it does other standard health benefits. They also have no donation limitations and may collaborate with enterprises of any size. Stipends may be more economical and simpler to manage for certain employers, particularly small company owners.

Stipends are a set amount of money provided to workers to spend on whatever the employer chooses, such as a health insurance policy (including supplementary plans like dental and vision care) and other out-of-pocket medical costs. You can provide them with any type of health benefit, such as a regular group health plan or an HRA.

According to the IRS, stipends are additional earnings paid to your employees' paychecks. This makes the amount taxable at the end of the year, but your workers will have more options for how to spend their stipend money.

It's vital to note that health stipends do not meet the employer obligation for ALEs. If you are an ALE, you must provide a group plan or an ICHRA in addition to your health stipend to fulfill the employer mandate requirements, or you will face significant fines.

Conclusion

While a variety of health insurance providers provide corporations with standard group health benefits, it is critical to examine alternative, more flexible choices.

HRAs and health stipends are a simple way to provide an affordable health benefit without getting too involved with group plan management. They also give your workers the freedom to choose the best health coverage for them. If you're an employer thinking about offering an HRA or stipend, we'd love to help you get started.