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The Largest Health Insurers Based On Market Share In The USA

The top five largest health insurers across the United States haven’t quite changed their rankings in the last six years or so. According to data from the annual health insurer competition report by the American Medical Association, UnitedHealth Group holds the first position. However, if you take a look at the recent list, you notice some small changes.

At the same time, Anthem, Aetna, and Cigna retain the second, third, and fourth positions, respectively. But Kaiser has burst into the top five in 2020 and currently holds the fifth position. This is indeed a significant change. Below is a detailed discussion of everything you need to know about the largest health insurers in the United States based on market share.

UnitedHealth Group

The largest market share in 2020 across the United States was that of the UnitedHealth Group, even though its shares went down compared to 2014. The company held on to 16 percent of the market share in 2014, whereas it occupies 15 percent of the market share now. Considering 2021’s first quarter, it caters to 49.5 million consumers across all the health insurance products it offers.

Interestingly, UnitedHealth Group doesn’t stay at the first position when considering the data from each state and metropolitan statistical region. It comes down to third place as far as market share size is concerned. In 2021, UnitedHealth made its way again into the Affordable Care Act or ACA marketplace. The healthcare payer has now joined the North Carolina, Oklahoma, the District of Columbia, Maryland, and Washington urban exchanges.


Going by the rankings as per the national market share, Anthem is second. The market share of the healthcare payer has dropped from 13 percent in the year 2014 to 12 percent in 2020. Taking 2021’s second quarter into account, Anthem caters to 44 million consumers. Though anthem might be ranking below UnitedHealth Group as per national market share, it ranks above UnitedHealth according to the data received from the states and the metropolitan statistical regions.

With the highest market share in the metropolitan areas, the anthem is way ahead of the other insurers. According to reports, the payer occupies the largest market share in more than 75 metropolitan areas. UnitedHealth Group leads in 22 of them. An expansion in Anthem’s Medicare Advantage plan options has helped it to expand. The company announced that it would be joining hands with Kroger Health in 2021 to bring up a Medicare Advantage Plan. People in Ohio, Kentucky, Virginia, and Georgia will be able to avail this plan.


Aetna has an 11 percent market share back in the year 2014. It maintained that in 2020. Thirty-nine million consumers have signed up for the medical, dental, and pharmaceutical coverage offered by Aetna. 23.4 million of the total membership have enrolled for Aetna’s medical health plan as of 2021’s fourth quarter. Nationally, with a six percent market share, Aetna was placed fifth.

In 2015, Aetna had a nine percent market share, which keeps them at position three. Despite this improvement, Aetna decided to exit from the Affordable Care Act marketplaces and the other significant insurers in 2018. However, it has been revealed in 2021 that the payer has plans to re-enter the ACA marketplaces.


Cigna’s market share of eight percent in 2014 increased to ten percent in 2020. As per the reports received in August 2021, Cigna has 20.4 million people subscribed to its plan. According to the data revealed by the American Medical Association, Cigna didn’t have a top ten ranking until 2020, when it grabbed the tenth position with the help of its two percent market share. Recently, the insurer has announced an expansion. Cigna has intentions to enter the individual health insurance marketplace in Pennsylvania, Mississippi, and Georgia in 2022.


In the exchanges, the performance of Kaiser has improved a lot from 2014. Having a five percent market share in 2014 on national levels, Kaiser occupied sixth place. With an increase in market share to seven percent, the payer has climbed up to the fifth spot. With an eight percent market share in 2020, it took third place.

Four of the five remaining payers in the top ten list have two percent of the market share. Of these, Centene’s rise to the tenth position amazed all market analysts, as they were in seventy-sixth position just a few years back. Is your health insurance provider on this list?

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