Over the past few years the health insurance industry has experienced a series of major mergers and acquisitions, further consolidating power into the hands of a few dominant companies — leaving Americans with fewer options.
In 2018, CVS Health (CVS) acquired Aetna. That same year Cigna (CI) bought Express Scripts and in 2023, Kaiser Permanente merged with Geisinger.
As of 2023, just four health insurers control a staggering 50% of the market, while six companies account for 30% of all healthcare spending in the United States.
While these mergers have boosted profits for these companies, they also, in some cases, raised premiums for consumers.
Here is a ranking of the largest health insurance companies by market share:
Centene (CNC), Blue Shield of California, Blue Cross Blue Shield (BCBS) of Michigan, and BCBS of Florida each hold 2% of the market.
Kaiser Permanente, which merged with Geisinger in 2023, has a market share of 7%
Health Care Service Corporation, which generated $54 billion in revenue in 2023, controls 7% of the market.
Cigna, which bought Express Scripts and in 2023, holds 11% of the market.
CVS Health, the parent company of Aetna, controls 12% of the market.
Elevance Health (ELV), formerly known as Anthem, comes in second place in the ranking, holding 12% of the market.
UnitedHealth Group (UNH), the parent of United Healthcare, is the largest health insurance company in the U.S. with a market cap north of $500 billion. It serves more than 29 million Americans and controls 15% of the market.
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