25 Largest Health Insurance Companies in the USA

 

25 Largest Health Insurance Companies in the USA- According to National Association of Insurance Commissioners (NACI), there are 25 Largest Health Insurance Companies in the USA. This data can be obtained from the market share data report entitled “Combined Accident and Health Insurance Market Share Reports” published by NAIC in 2023.

Commonly, many people still use health insurance to guarantee human health. Many activities and unpredictable risks can harm our health. So, to reduce the unpredictable cost of diseases, many people trust the insurance companies to deal with it.

Particularly, The United States of America (USA) with more than 300 million people is one of the main markets of insurance industries especially health insurance. Many insurance companies launched and had the product of insurance health to help the USA’s People.

Many health insurance companies in the USA. They offered the members or customers diversified health insurance products. Here is the rank of 25 Largest Health Insurance Companies in the USA. Maybe, some of us know and use their products or services.

 

The Rank of 25 Largest Health Insurance Companies in the USA

 

Rank	Health Insurance Companies	Direct Premiums	Market Share
	in The United States of America (USA)	(US Dollar (USD))	(%)
1	CVS Group	56,271,699,575	22.66
2	UnitedHealth Group	55,196,096,585	22.23
3	Cigna Healthcare Group	29,876,679,711	12.03
4	Metropolitan Group	11,214,262,315	4.52
5	Unum Group	7,113,111,617	2.86
6	Mutual Of Omaha Group	6,186,325,065	2.49
7	Aflac Group	5,345,351,317	2.15
8	Guardian Life Group	5,131,991,756	2.07
9	Sun Life Financial Inc Group	4,641,509,314	1.87
10	Hartford Fire & Cas Group	3,989,174,913	1.61
11	Tokio Marine Holdings Inc Group	3,951,443,395	1.59
12	Lincoln National Group	3,586,537,173	1.44
13	New York Life Group	3,289,810,455	1.32
14	Voya Financial Group	2,837,012,081	1.14
15	Principal Financial Group	2,779,772,548	1.12
16	Meiji Yasuda Life Insurance Group	2,670,958,104	1.08
17	Northwestern Mutual Group	2,461,947,969	0.99
18	Genworth Financial Group	2,332,719,048	0.94
19	Blue Cross and Blue Shield of Kansas	2,297,881,346	0.93
20	Prudential Group	2,207,658,411	0.89
21	CNO Financial Group	1,738,013,627	0.7
22	Centene Corp Group	1,686,259,326	0.68
23	Allstate Insurance Group	1,681,959,164	0.68
24	Fidelity Security Group	1,488,845,135	0.6
25	John Hancock Group	1,481,668,985	0.6
Industry Total		248,313,126,433	100

 

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The Histogram Rank of 15 Largest Health Insurance Companies in the USA

 

 

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Brief Description of Largest Health Insurance Companies in the USA

 

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1. CVS Group    

CVS Health Corporation is a diversified health solutions company. Historically, this company was founded in 1963 by Stanley Goldstein, Sidney Goldstein, and Ralph Hoagland. As of December 31, 2024, CVS Health Corporation had more than 9,000 retail locations, more than 1,000 walk-in and primary care medical clinics, a leading pharmacy benefits manager with approximately 90 million plan members and expanding specialty pharmacy solutions, and a dedicated senior pharmacy care business serving more than 800,000 patients per year. Financially, in the year 2024, according to its annual report, the total assets of CVS Health Corporation reached USD 253 billion with total liabilities of around USD 177 billion. In terms of business performance in 2024, CVS Health Corporation successfully gained total revenue of USD 372 billion with net income reaching USD 4.5 billion. Furthermore, in the health insurance business, according to the NAIC report, CVS Group gained a direct premium of around 56.2 billion in 2023.

 

2. UnitedHealth Group

UnitedHealth Group is one of the largest health insurance companies in the USA that was founded in 1977 by Richard Burke. Commonly, UnitedHealth Group provides insurance services under UnitedHealthcare and healthcare products under Optum. Operationally, UnitedHealth Group has had a central office in Minnetonka, Minnesota and has grown with a labor force reaching 440,000 people.

Financially, in 2023, in terms of financial position, UnitedHealth Group has total assets amounting to USD 273 billion and total liabilities reaching USD 174 billion. Furthermore, the UnitedHealth Group also generated substantial revenue, with total revenue standing at USD 371 billion and reported gaining a net income of USD 23 billion. Specifically, in the health insurance, UnitedHealth Group successfully gained direct premium USD 55,196,096,585.

 

3. Cigna Health Group  

Cigna is a multinational healthcare and insurance company. Operationally, this company has a primary office in Bloomfield, Connecticut, United States of America. Historically, this company was founded in 1982 because of the merger between Connecticut General Life Insurance Company (CG) and INA Corporation. Financially, in 2023, Financially, according to the annual report in 2023, Cigna has total assets recorded at USD 152 billion, while total liabilities reached USD 106 billion. In terms of business conditions, Cigna successfully gained a net income of USD 5.3 billion. Moreover, in the health insurance business, according to the NAIC report, Cigna Health Group gained a direct premium written around 29.8 billion in 2023.

 

4. Metropolitan Group 

Metropolitan Insurance Group Inc. is an insurance company that has a head office in Chicago, Illinois. Commonly, in health insurance, according to the NAIC report, Metropolitan Group successfully collected direct premium around USD 11.2 billion in 2023.

 

5. Unum Group    

Unum Group is an American insurance company headquartered in Chattanooga; Tennessee incorporated in 1848 at Maine. Commonly, Unum has operated in some countries including the United States, United Kingdom, Poland, and others with total employees of around more than 10,000 people. Financaially in 2024, in terms of business position, Unum Group has total assets of around USD 61 billion with total liabilities of around USD 50.9 billion. Furthermore, in 2024, Unum Successfully gained total revenue of USD 12.8 billion with total net income of around USD 1.7 billion. Specifically, in the health insurance industry, Unum Group has gained a direct premium of USD 7.1 billion with a market share of 2.86 % in the USA’s market.

 

6. Mutual Of Omaha Group    

Mutual of Omaha is an insurance and financial company that has a central office in Omaha, Nebraska. Historically, this company was founded in 1909. As of September 1st, 2023, Mutual of Omaha received financial ratings from several financial institutions, namely A+ from A.M. Best Company, A1 from Moody’s, A+ from S&P Global. Financially, according to the annual report of the company in 2023, Mutual of Omaha has total assets of USD 10.9 billion with total liabilities of USD 6.9 billion. In the business aspects, Mutual of Omaha suffered a net loss of USD 31 million. Furthermore, according to the report of NAIC in 2023 in the health insurance industry, Mutual of Omaha gained a direct premium of USD 6.1 billion with a market share of around 2.49 %.

 

7. Aflac Group

Aflac Group Insurance was founded in Columbia, South Carolina, in 1980 and still has a head office in Columbus, Georgia. Financially, according to its annual report in 2024, Aflac insurance has total assets of around USD 117.6 billion with total equity of around USD 26.10 billion. In terms of business performance in 2024, Aflac successfully gained total revenue of around USD 18.9 billion and successfully gained net income of around USD 5.443 billion. Specifically, in the health insurance industry in the US Market, Aflac Group successfully gained a direct premium of USD 5.3 billion with a market share of 2.15 %.

 

8. Guardian Life Group 

Guardian Life’s insurance and investment company that was founded in 1860 by Hugo Wesendonck. Along with business development, Guardian has employed 8,000 people. Furthermore, Guardian still has a central office in New York. Financially, according to the annual report of 2023, total assets of Guardian Life reached USD 80.2 billion with total liabilities of USD 71.1 billion. In terms of business performance, Guardian Life gained net income of USD 362 million. In the market share data report of NAIC, Guardian Life Insurance gained a direct premium of around USD 5,131,991,756        in the United States of America (USA) with market share of around 2.07 %.

 

9. Sun Life Financial Inc Group        

Sun Life Financial Inc. is a Canadian financial and insurance company that has a central office in Toronto, Ontario. Historically, this company was founded in 1865 by Matthew Hamilton Gault, an immigrant from Ireland. With the development of Sun Life Financial, this company has around 66,900 employees, 95,000 advisors, in 28 markets serving more than 85 million of its customers. Financially, according to the annual report in 2024, Sun Life's total assets were recorded at CAD 370 billion, while total liabilities reached CAD 344 billion. In terms of business conditions, Sun Life successfully achieved a net income of CAD 3.2 billion. In the health insurance industry, Sun Life gained a direct premium of USD 4.6 billion with a total market share of 1.87 %.

 

10. Hartford Fire & Cas Group         

Hartford Insurance started the business in 1810 as a fire insurance company. Nowadays, this company is also one of the biggest insurance companies in Property & casualty (P&C) insurance industries with total employees of Approximately 18,700 people. As of December 31, 2023, total assets and total stockholders’ equity of The Hartford were $76.8 billion and $15.3 billion. In terms of business performance, Hartford Insurance gained total revenue of USD 24.5 billion with a net income of USD 853 million. Overall, according to the National Association of Insurance Commissioners (NAIC), the direct premium of Hartford insurance in the health insurance segment reached USD 3.9 billion with a total market share of around 1.61 %.

 

11. Tokio Marine Holdings Inc Group        

Tokio Marine Holdings, Inc. is an insurance company that has a primary office in Tokyo. Historically, this company was founded in 1879. Along with the business development of the company, Tokio Marine operated in 46 countries with total employees of 43,000 people worldwide. Financially, as of March 2023, Tokio Marine holding has total assets of JPY 27.6 trillion and gained net adjusted income reaching JPY 444 billion. In the health insurance industry, according to the report of National Association of Insurance Commissioners (NAIC), Tokio Marine Holdings gained a direct premium of USD 3.9 billion with market share of around 1.59 %.

 

12. Lincoln National Group     

Lincoln National Corporation or Lincoln Financial Group is an Insurance and Asset Management company that was founded in 1905 by Perry Randall. Based on the financial ratings, Lincoln National got AM Best (A), Fitch (A+), Moody’s (A1), and S&P (A+). Based on the business performance, Lincoln National suffered net loss around USD -2.2 billion. Specifically, in the health market, the data from the National Association of Insurance Commissioners (NAIC) in 2023 showed that Lincoln Financial gained $ 3,586,537,173 of direct premium written in the health insurance of the United States of America (USA) with a market share of 1.44 %.

 

13. New York Life Group        

New York Life Insurance Company (NYLIC) is one of the largest insurance companies in the United States. Operationally, this company has 12,000-plus agents and advisors to serve its customers. In terms of financial conditions according to the Balance sheet, the company has total assets around USD 231 billion with total liabilities around USD 206 billion. Based on the business performance in 2023, the company gained total revenue of USD 23 billion with net income around USD 0.027 billion. Specifically, in health insurance, New York Life has gained a direct premium of USD 3,289,810,455 with a market share of 1.32 %.

 

14. Voya Financial Group        

Voya Financial is an insurance company based in New York City. In the U.S. Market Voya is one of the leading providers of supplemental health insurance and offers comprehensive insurance products to businesses covering approximately 7.2 million individuals through the workplace. To date, Voya Financial has employees of around 10,000 people. Financially, according to the annual report, Voya Financial successfully gained net income reaching USD 626 million. In the health insurance market, Voya Financial successfully gained a direct premium of USD 2,837,012,081 with market share of 1.14 %.

 

15. Principal Financial Group 

Principal Financial Group, Inc is an American global financial investment management and insurance company headquartered in Des Moines, Iowa, United States which employs roughly 9,000 people. Historically, this company was founded in 1879 by Edward Temple. Financially, in the year 2024, Principal Financial Group has total assets of USD 305 billion with total liabilities of around USD 293 billion. In terms of business performance in 2024, Principal has successfully gained total revenue of USD 13.6 billion and net income of USD 670 million. Specifically, in the Health Insurance industry, Principal Financial successfully collected a direct premium of USD 2,779,772,548 and still has a market share of 1.12 %.

 

16. Meiji Yasuda Life Insurance Group      

Meiji Yasuda Life Insurance Company was established July 9, 1881. Operationally, Meiji Yasuda has total employees of around 47,493 people with total assets of JPY 46,457.8 billion. Financially, in the year of 2024, Meiji Yasuda has a direct premium of USD 2,670,958,104 and has a market share of 1.08 %.

 

17. Northwestern Mutual Group       

Northwestern Mutual was founded in 1857 and has been developed into one of the biggest insurance companies in USA. Northwestern still became one of the most trusted companies in the life insurance industries with some good ratings from several financial institutions. As of 2023, Northwestern Mutual received AA+ from S&P Global, Aaa from Moody’s, AAA from Fitch Ratings, and A++ from A.M. Best Company. Furthermore, According to Annual Report in 2022, Northwestern Mutual gained net income around $912 million with total assets around $340 billion.

Financially, according to the annual report in 2023, Northwestern Mutual has total assets of USD 358 billion with total liabilities of USD 320 billion. Furthermore, in 2023, based on business performance in 2023, Northwestern Mutual gained total revenue of USD 36.1 billion with net income of USD 0.71 billion. In addition, according to NAIC’s market share data report in 2023, Northwestern Mutual got USD 2,461,947,969 in the health insurance industry in the U.S. market.        

 

18. Genworth Financial Group

Genworth Financial, headquartered in Richmond, Virginia, was founded in 1871. To date, the number of employees of Genworth financial has reached 2,500 people. Financially, in the year 2024, total assets of Genworth Financial reached 86 billion with total liabilities of around USD 77 billion. In terms of business performance in 2024, total revenue of Genworth Financial reached USD 7.2 billion with a net income of USD 427 million. Specifically, in the health insurance industry, Genworth Financial Group successfully gained a direct premium of USD 2,332,719,048 with a market share of 0.94 %.

 

19. Blue Cross and Blue Shield of Kansas (BCBSKS)

Blue Cross and Blue Shield of Kansas (BCBSKS) is Blue Cross and Blue Shield of Kansas City (Blue KC) is an independent licensee of the Blue Cross Blue Shield Association, and a not-for-profit health insurance provider founded 1938. To date, the number of employees of Blue Cross and Blue Shield of Kansas has reached 1,000 people. Financially, in the health insurance industry, Blue Cross and Blue Shield of Kansas gained a direct premium of USD 2,297,881,346 with market share of 0.93 %.

 

20. Prudential Group     

Prudential Financial, Inc. is an American insurance company that was founded in 1875. Along with business development, Prudential Financial has 50 million customers in over 50 countries in the United States, Asia, Europe, and Latin America. In the financial aspects, total assets of Prudential are around USD 721 billion with total liabilities of USD 691 billion. In terms of the business performance in 2023, the company has total revenue of USD 53.9 billion and successfully gained net income of USD 2.5 billion. In addition, according to the NAIC report, Prudential Financial gained USD 2,207,658,411 direct premium of health insurance in the United States of America (USA).

 

21. CNO Financial Group        

CNO Financial Group, Inc. is an American financial and insurance services holding company based in Carmel, Indiana incorporated in 1979 as Security National of Indiana Corp. by Stephen Hilbert. Financially, as of December 31, 2024, total assets of CNO Financial reached USD 37.9 billion and shareholders' equity of USD 2.5 billion. In terms of business performance in 2024, CNO Financial Group had revenues of $4.4 billion and net income of $404.0 million. Specifically, in 2024, CNO Financial Group has a direct premium of USD 1,738,013,627 with market share of 0.7 %.

 

22. Centene Corporation Group        

 

Centene Corporation is a health insurance and Pharmacy company which was founded by Elizabeth Brinn as the Health Services Managed in Milwaukee, Wisconsin, in 1984. To date, Centene Corporation has several employees, reaching 60,500 people. Financially, in 2024, Centene Corporation has revenue USD 163 billion with net income of USD 3.31 billion. In terms of financial position, total assets of Centene Corporation reached USD 82.4 billion and total equity reached USD 26.4 billion. Specifically, in the health insurance market, Centene Corporation has a direct premium of USD 1,686,259,326 with a market share of 0.68 %.

 

23. Allstate Insurance Group   

The Allstate Corporation was founded on April 17, 1931, and the headquarters of Allstate located in Northbrook, Illinois, U.S.A. As of 2023, The Allstate Corporation has 53,400 employees, 9,100 exclusive agents and agent support staff, 20,200 licensed sales professionals and 50,900 independent agents. Furthermore, Allstate has 194 million policies in force in 2023.

Financially, in 2023, Total assets were recorded at USD 103 billion, while total liabilities reached USD 85 billion. In terms of business performance, Allstate generated total revenue of USD 57.9 billion, but Allstate suffered a net loss of USD 0.21 billion. Specifically, in 2023, in the health insurance industry, Allstate Insurance collected a direct premium of USD 1,681,959,164 with market share of 0.68 %.

 

24. Fidelity Security Life Insurance Group 

 

Fidelity Security Life Insurance Company (FSL) was founded in 1969 and still has headquarters in Kansas City, Missouri. In the health insurance industry, Fidelity Security has collected direct premiums of USD 1,488,845,135 with market share of 0.6 %.

 

25. John Hancock Group         

John Hancock Insurance Company, U.S.A. is a Boston-based insurance company that was established April 21, 1862. Empirically, the company’s name was destined in honor of John Hancock, one of the prominent American Patriots. Financially, in the health insurance industry, John Hancock earned USD 1,481,668,985 according to the Report of National Association of Insurance Commissioners (NAIC) in the United States’ life insurance market.

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Bibliography of 25 Largest Health Insurance Companies in the USA

National Association of Insurance Commissioners. 2023. Combined Accident and Health Insurance Market Share Reports. Accessed via https://content.naic.org/article/naic-releases-2024-market-share-data on September 5th, 2023.

CVS Group. 2025. Annual Report 2024. Accessed via https://investors.cvshealth.com/investors/financial-information/annual-reports-archive/ on April 10th, 2025.

UnitedHealth Group. 2025. Annual Report 2024. Accessed via https://www.unitedhealthgroup.com/investors/financial-reports.html on April 10th, 2025.

Cigna Healthcare Group. 2025. Annual Report 2024. Accessed via https://investors.thecignagroup.com/financials/annual-reports/default.aspx  on April 10th, 2025.

Metropolitan Group. 2025. Annual Report 2024. Accessed via on https://investor.metlife.com/financials/annual-reports/   April 10th, 2025.

Unum Group. 2025. Annual Report 2024. Accessed via https://investors.unum.com/financials/annual-reports/default.aspx  on April 10th, 2025.

Mutual Of Omaha Group. 2025. Annual Report 2024. Accessed via https://www.mutualofomaha.com/about/financial-strength/financials  on April 10th, 2025.

Aflac Group. 2025. Annual Report 2024. Accessed via https://investors.aflac.com/financials/annual-reports-and-proxy/default.aspx  on April 10th, 2025.

Guardian Life Group. 2025. Annual Report 2024. Accessed via https://www.guardianlife.com/about-guardian/annual-report   on April 10th, 2025.

Sun Life Financial Inc Group. 2025. Annual Report 2024. Accessed via https://www.sunlife.com/en/investors/financial-results-and-reports/annual-reports/   on April 10th, 2025.

Hartford Fire & Cas Group. 2025. Annual Report 2024. Accessed via https://ir.thehartford.com/financials/annual-reports/default.aspx  on April 10th, 2025.

Tokio Marine Holdings Inc Group. 2025. Annual Report 2024. Accessed via https://www.tokiomarinehd.com/en/ir/download/annual_report.html   on April 10th, 2025.

Lincoln National Group. 2025. Annual Report 2024. Accessed via https://www.lincolnfinancial.com/public/aboutus/investorrelations/financialinformation/annualfilings   on April 10th, 2025.

New York Life Group. 2025. Annual Report 2024. Accessed via https://www.newyorklife.com/about/financial-information  on April 10th, 2025.

Voya Financial Group. 2025. Annual Report 2024. Accessed via https://investors.voya.com/financials/annual-reports-and-proxy/default.aspx   on April 10th, 2025.

Principal Financial Group. 2025. Annual Report 2024. Accessed via https://investors.principal.com/financials/proxy-annual-reports on April 10th, 2025.

Meiji Yasuda Life Insurance Group. 2025. Annual Report 2024. Accessed via https://www.meijiyasuda.co.jp/english/disclosure/annual-reports/backnumber/2023.html   on April 10th, 2025.

Northwestern Mutual Group. 2025. Annual Report 2024. Accessed via https://www.northwesternmutual.com/investor-relations/   on April 10th, 2025.

Genworth Financial Group. 2025. Annual Report 2024. Accessed via https://investor.genworth.com/company-information/annual-reports-proxy  on April 10th, 2025.

BCBS Of KS Group. 2025. Annual Report 2024. Accessed via https://www.bcbsks.com/annual-report  on April 10th, 2025.

Prudential Group. 2025. Annual Report 2024. Accessed via https://www.prudentialplc.com/en/investors/reports/2024   on April 10th, 2025.

CNO Financial Group. 2025. Annual Report 2024. Accessed via https://ir.cnoinc.com/financials/annual-reports/default.aspx   on April 10th, 2025.

Centene Corp Group. 2025. Annual Report 2024. Accessed via https://investors.centene.com/all-filings  on April 10th, 2025.

Allstate Insurance Group. 2025. Annual Report 2024. Accessed via https://www.allstatecorporation.com/about/annual-report.aspx  on April 10th, 2025.

Fidelity Security Group. 2025. Annual Report 2024. Accessed via https://www.fslins.com/Annual-Report  on April 10th, 2025.

John Hancock Group. 2025. Annual Report 2024. Accessed via https://www.johnhancock.com/about-us/newsroom/media-resources/key-reports.html  on April 10th, 2025.