Largest Commercial Health Insurers by Premiums (2024)

Kaiser Permanente collects more premiums than any other insurer in the fully insured commercial health market: $64.0 billion in 2024, according to CMS data. UnitedHealth Group and Elevance Health follow. Insurers earned $512 billion in commercial health premiums that year, and the largest five groups took 46% of it.

Every figure is from the Medical Loss Ratio reports insurers file with CMS for each state they sell in, as published in CMS's public use file for 2024.

The 30 largest commercial health insurers

Insurers are ranked by direct premiums earned in comprehensive medical coverage sold to individuals, small employers and large employers, with each insurance company counted under the group it reports belonging to. The last column is the share of those premiums the group reported paying out in claims.

Rank	Insurer	Commercial premiums	Share	Individual	Small group	Large group	Claims as a share of premiums	Source
1	Kaiser Permanente	$64.0 billion	12.5%	$7.2 billion	$5.8 billion	$51.0 billion	92%	CMS
2	UnitedHealth Group	$49.4 billion	9.6%	$9.4 billion	$12.8 billion	$27.2 billion	81%	CMS
3	Elevance Health	$48.9 billion	9.5%	$8.4 billion	$9.4 billion	$31.1 billion	86%	CMS
4	Health Care Service Corporation	$45.9 billion	9.0%	$13.9 billion	$8.9 billion	$23.1 billion	91%	CMS
5	Centene	$28.3 billion	5.5%	$25.1 billion	$803 million	$2.4 billion	79%	CMS
6	CVS Health (Aetna)	$27.5 billion	5.4%	$10.2 billion	$775 million	$16.5 billion	91%	CMS
7	Florida Blue	$23.0 billion	4.5%	$14.0 billion	$1.9 billion	$7.1 billion	87%	CMS
8	Cigna	$19.9 billion	3.9%	$3.6 billion	$422 million	$15.8 billion	88%	CMS
9	Blue Shield of California	$18.9 billion	3.7%	$7.9 billion	$3.8 billion	$7.2 billion	87%	CMS
10	CareFirst	$10.6 billion	2.1%	$1.4 billion	$2.2 billion	$7.0 billion	84%	CMS
11	Highmark	$10.1 billion	2.0%	$2.0 billion	$1.5 billion	$6.6 billion	93%	CMS
12	Blue Cross Blue Shield of Michigan	$9.3 billion	1.8%	$1.1 billion	$1.7 billion	$6.5 billion	90%	CMS
13	Blue Cross and Blue Shield of North Carolina	$7.9 billion	1.5%	$3.6 billion	$1.3 billion	$3.0 billion	86%	CMS
14	Blue Cross Blue Shield of Massachusetts	$7.1 billion	1.4%	$241 million	$1.3 billion	$5.6 billion	92%	CMS
15	Blue Cross and Blue Shield of Alabama	$6.5 billion	1.3%	$1.9 billion	$1.2 billion	$3.4 billion	93%	CMS
16	Oscar Health	$6.4 billion	1.3%	$6.4 billion	$6 million	$0	108%	CMS
17	Regence	$5.9 billion	1.2%	$840 million	$1.5 billion	$3.6 billion	90%	CMS
18	Horizon Blue Cross Blue Shield of New Jersey	$5.6 billion	1.1%	$2.3 billion	$1.4 billion	$2.0 billion	112%	CMS
19	Independence Blue Cross	$5.1 billion	1.0%	$1.7 billion	$1.3 billion	$2.1 billion	82%	CMS
20	BlueCross BlueShield of South Carolina	$4.6 billion	0.9%	$2.2 billion	$462 million	$1.9 billion	85%	CMS
21	Premera Blue Cross	$4.4 billion	0.9%	$588 million	$500 million	$3.3 billion	89%	CMS
22	Blue Cross and Blue Shield of Louisiana	$4.2 billion	0.8%	$1.3 billion	$1.1 billion	$1.8 billion	84%	CMS
23	BlueCross BlueShield of Tennessee	$4.1 billion	0.8%	$971 million	$665 million	$2.4 billion	87%	CMS
24	Wellmark	$3.9 billion	0.8%	$876 million	$954 million	$2.1 billion	85%	CMS
25	EmblemHealth	$3.7 billion	0.7%	$950 million	$108 million	$2.7 billion	83%	CMS
26	Medica	$3.6 billion	0.7%	$1.0 billion	$442 million	$2.1 billion	92%	CMS
27	Intermountain Health (SelectHealth)	$3.5 billion	0.7%	$1.9 billion	$654 million	$1.0 billion	87%	CMS
28	Harvard Pilgrim Health Care	$3.4 billion	0.7%	$411 million	$1.0 billion	$1.9 billion	95%	CMS
29	Corewell Health	$3.2 billion	0.6%	$871 million	$538 million	$1.8 billion	92%	CMS
30	Blue Cross and Blue Shield of Minnesota	$2.9 billion	0.6%	$338 million	$617 million	$2.0 billion	93%	CMS

Download this table (CSV), free, with the group affiliations and companies behind each name. The full dataset, every insurer's filing state by state with its premiums, claims and covered lives, is one email away.

How the commercial market divides

• The largest five groups take 46% of commercial health premiums reported to CMS, and the largest ten 66%. The smallest group in the table earned $2.9 billion.
• Large employer coverage is 54% of the market, small employer coverage 15% and individual coverage 31%, according to CMS data. Centene leads the individual market.
• Nonprofit insurers, most of them Blue plans and Kaiser Permanente, earned 51% of the premiums.
• Across the market, insurers reported paying 88% of premiums back out in claims.
• The filings come from 484 insurance companies in 184 groups.

What this means for technology buyers

A commercial health plan runs on claims, billing and compliance systems that have to work state by state. These guides compare the options:

• Claims management systems for health insurers: adjudicating and paying claims at plan scale.
• Billing and invoicing platforms for insurance carriers: premium billing to employers and individuals.
• Regulatory compliance software for insurers: filings like the ones this page is built from.

Mapping the business? The Health Insurance Capability Model sets out what a health plan does, and the Health Insurance Value Streams show how that work runs end to end.

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How this list was built

The universe is every Medical Loss Ratio report in CMS's public use file for 2024. Every insurer selling fully insured comprehensive medical coverage files one for each state it sells in. Premiums are direct premiums earned in the individual, small group and large group markets for the year. Each company is counted under the group affiliation it reports, with the largest groups given the names their customers know. The state filings were checked against each insurer's own total across states.

Limits

• Commercial insured coverage only. Medicare Advantage, Medicaid managed care and employer plans that pay their own claims, with an insurer only administering them, are not in these filings. An insurer's total health revenue can be several times what is shown here.
• Claims share is not the regulatory MLR. The legal medical loss ratio adds spending on quality, deducts taxes and fees, averages three years and is calculated state by state and market by market. The column here is simpler: claims over premiums for one year.
• As filed. Figures are as insurers reported them to CMS. Covered lives are in the dataset as filed, including at least one figure that looks misreported, so the table leaves them out.
• Grouping is a judgment. The group affiliations and companies behind each name are in the free table.

Cite this

Free to quote, cite and republish, including the chart, with credit to Finantrix Atlas and a link to this page.

Kaiser Permanente earned $64.0 billion in fully insured commercial health premiums in 2024, the most of any insurer, according to a Finantrix Atlas analysis of CMS Medical Loss Ratio data.

The five largest insurance groups took 46% of the $512 billion in commercial health premiums reported to CMS for 2024, according to Finantrix Atlas.

Suggested citation: Finantrix Atlas, "Largest Commercial Health Insurers by Premiums," 2024, from CMS Medical Loss Ratio public use files. https://www.finantrix.com/articles/largest-health-insurers-mlr

Embed the chart:

<a href="https://www.finantrix.com/articles/largest-health-insurers-mlr"><img src="https://www.finantrix.com/atlas/largest-health-insurers-mlr.png" alt="The largest commercial health insurers by premiums, from Finantrix Atlas"></a>
<p>Chart: <a href="https://www.finantrix.com/articles/largest-health-insurers-mlr">Finantrix Atlas</a>, from CMS Medical Loss Ratio data.</p>

Frequently asked questions

Q: Which health insurer collects the most commercial premiums? A: Kaiser Permanente, with $64.0 billion in fully insured individual and employer premiums in 2024, according to CMS data.

Q: How big is the commercial health insurance market? A: According to CMS, insurers earned $512 billion in fully insured commercial health premiums in 2024. Self-funded employer plans are not included.

Q: What is a medical loss ratio? A: The share of premiums an insurer spends on medical care and quality improvement. Under the Affordable Care Act it must be at least 80% in the individual and small group markets and 85% in the large group market, or the insurer owes customers a rebate.