List of the top 5 largest health insurance companies in the U.S.

Top 5 health insurance companies in Arizona

The top five largest health insurers are UnitedHealth Group, Anthem, Aetna, and Cigna, as well as one newcomer. According to the American Medical Association’s annual health insurer competition report, the top five largest health insurers at the national level have remained stable over the past six years, but there were a few small changes in 2020.

Kaiser rose to fifth place from fourth place in 2020, while UnitedHealth Group, Anthem, Aetna, and Cigna remained as the top four insurers.

According to AMA, market share data on national insurers does not accurately depict consumers’ experiences. The provider organization said market-level data is more accurate in describing the impact of industry consolidation on consumers.

According to the AMA, only the top three insurers reached 10 percent of the market, a testament to the limited number of national health insurers. 

A single state is home to three out of the ten largest national insurers. California and Florida were rank highest because both of them are among the states with a large market and population. In Michigan, which is the third state, only one insurer dominates nearly 70 percent of the market.

However, AMA acknowledged that the ranking of the nation’s Top 5 health insurance companies in Arizona at the national level does offer a helpful backdrop for localized data.


UnitedHealth Group retained its leading market share in 2020, although it declined slightly as compared to 2014. Earlier this decade, UnitedHealth Group had 16 percent market share, while in 2020 it held 15 percent.

As of the first quarter of 2021, the payer boasted nearly 49 million customers across all of its products.

UnitedHealth Group, however, drops to third place in market share size when measure by data from states and metropolitan statistical areas, where it is tie with Florida Blue. There are 22 metropolitan statistical areas in which the payers claim the highest market share.

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Oklahoma, North Carolina, Maryland, and Washington have high premiums, as of June 2018.

A national insurer will have 39% of exchange market share by 2020 versus 12% in 2015.


The company dropped slightly from 13 percent to 12 percent market share in 2020, remaining at second place to UnitedHealth Group in the national market share rankings.

As of the second quarter of 2021, there were approximately 44 million members enroll in the payer’s medical health plans.

The state and metropolitan statistical areas data show Anthem outpacing UnitedHealth Group even though it is not rank as high in the national market share. 

Compared to 80 metropolitan statistical areas, the payer holds the lion’s share in 22 metropolitan statistical areas.

A recent initiative by Anthem to offer Medicare Advantage plans may increase its size.

A Medicare Advantage plan with Kroger Health will be available in 2022 through a payer partnership announce in July 2021. Georgia, Kentucky, Ohio, and Virginia will be the four regions with Medicare Advantage plans available.


According to the company, it held on to its 11 percent market share in 2014 and 2020. 

Through Aetna’s health plans, the payer provides coverage to approximately 39 million members. At the end of the fourth quarter of 2020, 23.4 million people were enroll in medical health plans.

In 2014, Aetna was the fifth-largest company on the national exchanges with a six percent market share and third-largest with a nine percent market share in 2015. Even so, the payer, along with many other major payers, departed the Affordable Care Act marketplaces in 2018.

Aetna announced its intention to rejoin the Affordable Care Act marketplaces at the beginning of 2021.


As of 2020, Cigna’s share of the health insurance market has risen from eight to ten percent.

A report from ValuePenguin and Lending Tree shows that the payer enrolled approximately 20.4 million members by August 2021.

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A report from the American Medical Association found that Cigna didn’t reach the top ten largest health insurers on the ACA’s marketplace until 2020. Two percent of the market share helped it move into tenth place that year.

According to the payer, it plans to expand into many markets in 2021. 

For the 2022 plan year, Cigna will expand into Georgia, Mississippi, and Pennsylvania and will expand into more counties in Arizona, Florida, and Virginia. The payer is expecting to serve 1.5 million additional members in these areas.

A Cigna health plan for small businesses has also been extend through a partnership with Oscar Health. In California, eight counties will offer the Cigna + Oscar plan.

As part of their virtual primary care program, Cigna and Oscar Health have expanded their partnership. Tennessee and Georgia will soon be able to access the program, pending regulatory approval in 2022.


In terms of market share, Kaiser improved from fifth to fifth place in the national ranking between 2014 and 2020. 

Highmark and Kaiser tied for fourth place at the regional level with the most market shares.

In 2020, Kaiser handled the exchanges better than it did in 2014 or 2015. As the third-largest player in the exchange market in 2020, the payer achieved 8% market share. Kaiser was sixth in exchange market share for 2014 and 2015.

The remaining five health insurers that make up the top ten list of largest health insurers on a national level are comprise of only four insurers with two percent market share. 

The most notable alteration on the top ten list was the ascension of Centene to tenth place. Thus, Humana dropped from tenth place in 2014 to 76th place in 2020. AMA attributes Centene’s recent growth to its recent acquisitions and joining of exchanges.

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