Mapped: The Top Health Insurance Companies by State – Visual Capitalist

Map: Top health insurance companies by state

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The U.S. health insurance industry is highly concentrated, with a single insurer having at least 50% market share in 13 U.S. states.

Industry consolidation has exacerbated this trend over the past decade, leaving consumers with limited health insurance options. Furthermore, health care costs and expenses tend to be higher in markets dominated by a small number of insurance companies. higher This is because insurance companies are less likely to reimburse hospitals for treating patients.

This graphic shows the largest health insurance companies in the United States by state. american medical association.

Market concentration of medical insurance companies in 2023

Below are the top health insurers in each U.S. state as a percentage of total enrollees in 2023.

statetop medical insurance companiesMarket share in 2023
Alabamablue cross blue shield86%
kentuckyElevance Health67%
louisianablue cross blue shield66%
HawaiiHawaii Medical Services Association63%
illinoisHealthcare Service Co., Ltd.63%
south carolinablue cross blue shield59%
oklahomaHealthcare Service Co., Ltd.57%
vermont stateblue cross blue shield57%
Delawarehigh mark56%
IndianaElevance Health56%
west virginiahigh mark52%
mississippiblue cross blue shield50%
montanaHealthcare Service Co., Ltd.50%
new hampshireElevance Health48%
north carolinablue cross blue shield48%
north dakotablue cross blue shield48%
iowaWellmark47%
alaskaPremera46%
Utahmountainous area46%
arkansasblue cross blue shield45%
Kansasblue cross blue shield45%
nebraskablue cross blue shield45%
texasHealthcare Service Co., Ltd.44%
maineElevance Health43%
marylandcare first43%
Massachusettscare first43%
virginiaElevance Health43%
idahoblue cross idaho42%
rhode islandblue cross blue shield42%
tennesseeblue cross blue shield42%
wyomingSigna40%
new jerseyhorizon39%
minnesotablue cross blue shield38%
new mexicoHealthcare Service Co., Ltd.38%
CaliforniaKaiser37%
connecticutElevance Health37%
floridablue cross blue shield36%
nevadaunited health group36%
michiganblue cross blue shield35%
georgiaElevance Health33%
south dakotaavera health33%
ohioElevance Health31%
pennsylvaniahigh mark31%
missouriElevance Health29%
arizonaunited health group28%
wisconsinunited health group27%
new yorkunited health group26%
coloradoElevance Healthtwenty four%
OregonCambiatwenty one%
washingtonKaisertwenty one%

Last year, Blue Cross Blue Shield covered 86% of all enrollments. Alabamamaking it the most concentrated health insurance market nationally.

Ranked in second place was kentuckyElevance Health holds 67% of the market share. Overall, the six most populous states are located in the South. What's more, the region has higher uninsured rates than other regions driven by state opposition to Medicaid expansion.

In comparison, the northwestern states washington and Oregon The health insurance market is the least concentrated, with one company each controlling a 21% share.

Overall, Blue Cross Blue Shield was the top health insurer in 14 states, followed by Elevance Health in 10 states. Although UnitedHealth Group is America's largest insurance company nationally, it is relatively unconcentrated state-wide and is the top insurer in the following states: new york and arizona.

Change in business model

In addition to concentrated markets across states, many health insurance companies are diversifying into other non-insurance health services.

For example, Cigna, Wyoming's top health insurer, generated approximately 75% of its revenue from non-insurance services in the third quarter of 2023. For Elevance Health, non-insurance activities, from pharmacy services to primary care, accounted for 25% of revenue.

In many ways, we know that health insurance companies are becoming more vertically integrated, which also leads to higher prices and less competition in the health care system.

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If you would like to learn more about this topic from a national perspective, please click here. graphic About America's largest health insurance company.

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