Top 25 health insurance companies in the U.S.

Deciding to offer or enroll in health insurance is a crucial decision for employers, individuals, and families. It can be overwhelming to know where to start, especially if you’re a small business without an HR team or a benefits specialist. However, putting in the time and effort to set up a formal health benefits plan is well worth it.

Offering an employer-sponsored health insurance plan has several advantages, including helping retain and attract employees, making your business stand out, and contributing to a happy, healthy workforce.

In this article, we’ll list the top 25 health insurance companies in the United States by market share. We’ll also provide alternative coverage options if you want to offer something more cost-effective and flexible than traditional group health plans.

In this blog post, you’ll learn:

• What traditional group health insurance is, and why rising costs can be challenging for small and midsize employers.
• Which health insurance companies are the largest in the U.S. by market share in 2024.
• Alternatives to group health plans and how they can help employers control costs.

What is traditional group health insurance?

About 154 million individuals have an employer-sponsored group health plan. So, let’s review those types of policies before diving into the top health insurance companies in the U.S.

With traditional group health insurance, employers choose a group medical plan for their company and offer coverage to their employees and eligible dependents at a reduced rate. Most health insurers require businesses to fulfill a 70% minimum participation rate. If you don’t have enough employees who enroll in coverage, you won’t be able to offer the plan.

Insurance carriers offer various plan types, such as:

• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Exclusive provider organizations (EPOs)
• Point-of-service plans (POS)

A covered person must pay their share of the premium, which they’ll split with their employer. They'll also have to meet their annual deductible before their insurer begins sharing the cost of their medical claims.

According to KFF, the average annual premium for group health insurance in 2025 was¹:

• $9,325 for self-only coverage
• $26,993 for family coverage

Of those amounts, employers contributed the following on average toward premiums:

• $7,884 to their employees’ self-only plans
• $20,143 to their family plans

Employers can buy a group health policy directly from a private insurance carrier, licensed agent, or broker. Small businesses in many states can purchase a policy on the Small Business Health Options (SHOP) marketplace and apply for the small business health care tax credit to save on premiums.

While the familiarity of a group health plan makes it a popular choice for employers and employees, its high costs may be too much for smaller businesses to afford.

Group coverage isn’t the only way to purchase health coverage. Individuals can also buy their own health insurance policies from the Health Insurance Marketplace or state exchanges. Many of the same group carriers available offer individual health insurance plans. Employers can provide a stand-alone health reimbursement arrangement (HRA) to reimburse employees for their insurance premiums instead of opting for a group plan.

Top 25 U.S. health insurance companies listed by market share

Suppose you’re an employer interested in offering a group health plan or an individual looking to purchase a plan on a public or private exchange. In that case, it’s vital to understand which health insurance companies are popular and provide a wide range of products and medical services. One way to rank health insurance companies is by market share, or size, which reflects each company’s share of the health insurance market.

Below are the top 25 health insurance companies in the United States listed by market share size in descending order, according to the National Association of Insurance Commissioners’ (NAIC) 2024 Market Share Report², which was published in March 2025.

Market share size doesn’t necessarily correlate with the quality of the product or medical service, nor does it guarantee the company will retain its position throughout the year.

However, share size indicates advantages in market competition, financial health, and the structural security of the company, and insurers with higher market shares have larger direct written premiums. They may also have more extensive provider networks.

How much do health insurance companies receive in premium income?

According to the 2024 NAIC Health Insurance Report, health insurers in the United States earned approximately $1.2 trillion in total net earned premiums³. This was a 9% increase (or $122 billion) in premium spending from U.S. consumers in 2023.

UnitedHealth Group, which tops our above list as the largest in the insurance market, wrote roughly $269 billion in premium income in 2024. In contrast, Blue Cross Blue Shield of Massachusetts wrote $9.7 billion.

National health professionals in the insurance industry expect increased demand for medical services due to several factors, such as inflation, worsening health conditions, and an aging, higher-risk patient population.

Considering this, employers of all sizes can better attract and retain their employees by offering a range of health insurance options and other benefits, such as wellness programs, to support their employees’ future medical needs.

Why HRAs and health stipends are a better option than group coverage for small employers

With premium prices rising, it can be difficult for small and midsize businesses to budget for group medical insurance. Small organizations may also struggle to meet minimum participation requirements. However, more health insurance options exist for organizations that want to break free from traditional benefits. HRAs are one of those options.

An HRA is a health benefit you can use to reimburse employees, tax-free, for out-of-pocket medical services, health insurance premiums, or a combination of the two. With an HRA, you set a monthly allowance that your employees can spend on medical costs. Once employees make an approved purchase, you reimburse them up to their set allowance amount. This gives them more control over their healthcare and over their financial support for paying medical bills.

Below, we’ll go over four alternative health benefits that might be right for your organization.

Individual coverage HRA (ICHRA)

The individual coverage HRA (ICHRA) is a health benefit that can reimburse employees tax-free for individual health insurance premiums and other medical services and expenses. It’s for employers of all sizes and has no maximum contribution limits. Our digital tool has the complete list of eligible HRA expenses.

You can use the ICHRA as a stand-alone benefit instead of group health insurance. Or, you can offer it alongside a group health insurance policy. However, you can’t give your employees a choice between your group health plan and the ICHRA. You have to offer them one or the other using employee classes.

The ICHRA is customizable, so you can tailor it to your needs by setting different allowance amounts and eligibility for 11 employee classes. From there, employees simply choose to opt in or out of the benefit before it begins.

Only those with a qualified individual health plan can participate in the benefit. Employees will attest monthly that they still have individual health insurance coverage to continue receiving reimbursements.

Lastly, as long as you design your benefit with an affordable allowance for your employees, you can leverage an ICHRA to satisfy the employer mandate. This makes an ICHRA a great alternative to traditional group plans if you have 50 or more full-time equivalent employees (FTEs) and are looking to save money while still meeting Affordable Care Act (ACA) requirements.

Qualified small employer HRA (QSEHRA)

A qualified small employer HRA (QSEHRA) is a health benefit specifically for employers with fewer than 50 FTEs who don’t offer a group plan.

With a QSEHRA, you set an allowance up to the annual maximum contribution limit that works for your budget, and your staff picks the insurance policy and out-of-pocket medical expenses that work best for them and their families. QSEHRA reimbursements are income-tax-free for employees.

Individuals can use their QSEHRA to receive tax-free reimbursements for health insurance premiums and other out-of-pocket medical costs, such as mental health services, virtual care, and medication.

If you choose to offer a QSEHRA, you must offer it to at least all your W-2 full-time employees. You can also provide it to your part-time employees. But, to comply with federal regulatory policy, you must give them the same allowance amount as your full-time employees. Employees need a health plan that provides minimum essential coverage (MEC) to participate in the QSEHRA.

Integrated HRA

If you want to keep your group health insurance or switch to a high-deductible health plan (HDHP) to save on premiums, the integrated HRA is for you.

The integrated HRA, also known as a group coverage HRA (GCHRA), is for employers of all sizes offering a group health insurance plan who want to supplement their benefits. Like the QSEHRA and ICHRA, a GCHRA is a tax-free reimbursement method for employers wanting greater control over their health benefit plan costs.

Only employees who enroll in your group health plan can participate. Additionally, a GCHRA can’t reimburse premiums. But they can reimburse employees for eligible out-of-pocket costs, such as deductibles, prescription drugs, and pharmacy services.

Integrated HRAs have some unique perks over other HRAs. Employers can set any allowance amount, a pre-determined deductible, and a cost-sharing amount for employees. Similar to ICHRAs, there are seven employee classes that you can use to customize your integrated HRA.

By offering an integrated HRA, you can better support your employees’ individual healthcare needs while still maintaining your group health plan of choice.

Health stipend

Your last option for an alternative benefit plan is a taxable health stipend. The federal government doesn’t regulate stipends as much as other traditional health benefits. They also have no contribution limits and can work for companies of all sizes. So, stipends may be more affordable and easier to administer for some employers, especially small business owners.

Stipends are a fixed amount of money given to employees to cover medical expenses, such as health insurance, including supplemental plans like dental and vision coverage, and other out-of-pocket costs. You can offer them alongside any type of health benefit, whether that’s a traditional group health plan or an HRA.

The IRS considers stipends as extra wages added to your employees’ paychecks. This makes the amount taxable at the end of the year, but your employees will have more choice in how they can spend their stipend money.

It’s important to remember that health stipends don’t satisfy the employer mandate for ALEs. If you’re an ALE, you must offer a group plan or an ICHRA in addition to your health stipend to meet the employer mandate requirements or be subject to costly penalties.

How PeopleKeep by Remodel Health can help you provide individualized employee benefits

HRAs are an excellent way for small businesses to provide comprehensive health benefits. But you might be wary about administering them on your own. Luckily, PeopleKeep by Remodel Health can help you administer your HRA quickly and easily.

Our HRA administration software provides employers with a simple, effective way to manage their benefits. Our team of experts helps you manage your plan details and automates time-consuming tasks, like reviewing reimbursement requests and updating benefit plan documents. That way, you don’t have to worry about self-administration or making compliance errors.

From helping you design your benefit plan to award-winning customer support for your employees, PeopleKeep has what you need to add affordable and customizable benefits to your compensation package.

Conclusion

While the number of health insurance companies offers employers many ways to offer a traditional group health benefit, it’s essential to consider other, more flexible options.

HRAs are an easy way to offer affordable health benefits without diving headfirst into the waters of group plan administration. They also give your employees the autonomy to choose the health plans and provider networks that best suit them and their families. If you’re an employer considering an HRA, we would love to help you get started. Contact us today to learn more!

This article was originally published on January 13, 2020. It was last updated on February 13, 2026.

References

1. KFF 2025 Employer Health Benefits Survey
2. NAIC 2024 Market Share Reports For the Top 125 Accident and Health Insurance Groups and Companies by State and Countrywide
3. NAIC U.S. Health Insurance Industry Analysis Report - 2024 Annual Results