Health & Medical Insurance in the US - Market Research Report (2013-2028)
New York, United States
Last Updated: November 2023
NAICS 52411bRevenue
$1.3tr
Past 5-Year Growth
Profit
$XXX.Xbn
Employees
561k
Businesses
840
Wages
$XX.Xbn
Health & Medical Insurance in the US industry analysis
The Health and Medical Insurance industry, which is made up of carriers of private and public health, medical and dental insurance, has grown. This growth is a result of consistent increases in healthcare expenditure and medical cost inflation, in addition to a decline in the uninsured rate. Industry revenue is correlated with total health expenditure, as operators increase premiums to maintain profitability. Due to the COVID-19 pandemic, the industry experienced an influx of enrollment through expanded Medicaid eligibility, in addition to lower operating costs due to lower healthcare utilization. As unemployment increased, many people lost their employer-sponsored health insurance, causing limited growth in 2020. In the past five years, industry revenue grew at a CAGR of 3.6% to $1.3 trillion, including a 1.5% increase in 2023 alone, when profit increased to 9.1%.
Trends and Insights
- Consolidation will continue in the next couple of years. Smaller insurers don’t have the same power to take on increased costs stemming from regulation.
- Most revenue is generated from premiums that are related to fully funded insurance policies. Under this traditional form of coverage, the health insurer is responsible for paying the incurred coverage benefits and administration costs.
- Geographical distribution has changed little over the past decade. The distribution of health insurance is conducted on a state-by-state basis due to industry regulations.
- Reform pushes big insurers to get bigger. The healthcare reforms enacted in 2010 have been driving mergers and acquisitions, as insurers benefit from economies of scale and greater numbers of subscribers.
Industry Overview
Market size and recent performance (2013-2028)
Industry revenue has grown at a CAGR of 3.6 % over the past five years, to reach an estimated $1.3tr in 2023.
Trends and Insights
The response to the COVID-19 pandemic sustained industry revenue
- In the United States alone, the unemployment rate jumped as social-distancing measures exerted downward pressure on consumer spending and nonessential businesses were forced to temporarily close.
- Additional trends and insights available with purchase
Source: IBISWorld
Industry outlook (2024-2029)
Market size is projected to grow over the next five years.
Trends and Insights
The changing demographic and macroeconomics trends heavily affected revenue
- Millennials will become a more important market to the industry in the coming years. They are the largest age demographic and will require more of industry services as they get older.
Biggest companies in the Health & Medical Insurance in the US
| Company | Market Share (%)
2023 | Revenue ($m)
2023 | Profit ($m)
2023 | Profit Margin (%)
2023 |
|---|---|---|---|---|
Cvs Health Corporation | 333,475.2 | 15,478.9 | 4.6 | |
Unitedhealth Group Incorporated | 324,162.0 | 28,435.0 | 8.8 | |
Anthem, Inc. | 160,973.8 | 8,529.9 | 5.3 |
To view the market share and analysis for all 11 top companies in this industry, view purchase options.
Products & Services Segmentation
Source: IBISWorld
Industry revenue is measured across several distinct product and services lines, including Pharmacy benefit management (PBM), Preferred provider organization (PPO) plans and High-deductible health plans (HDHPs). Pharmacy benefit management (PBM) is the largest segment of the Health & Medical Insurance in the US.
Trends and Insights
Preferred provider organization (PPO) plans have increased in popularity
- A PPO plan is a combination of a traditional fee-for-service (FFS) plan and a Health maintenance organization (HMO). PPOs have a limited number of doctors and hospitals to choose from. The plan participant nominates a primary doctor who monitors the plan participant's health. When these preferred providers are used, most medical bills are covered.
- More insights available in the full report
Widen you competitive advantage with related industries
Competitors
- Disability Insurance in the US
Complementors
- Reinsurance Carriers in the US
- Health & Welfare Funds in the US
- Workers' Compensation & Other Insurance Funds in the US
- Emergency & Other Outpatient Care Centers in the US
International industries
- Global Life & Health Insurance Carriers
- Health Insurance in Australia
- Health Insurance in New Zealand
- General Insurance in the UK
- Dental Insurance in the UK
Table of Contents
About this industry
Industry definition
This industry underwrites (i.e. assumes the risks of and assigns premiums for) health and medical insurance policies. Insurance is the transfer of the risk of a loss in exchange for payment. Operators also provide administrative services for self-funded insurance plans. Under this structure, the industry operator is a third-party administrator and is not responsible for health benefit payments. This industry does not include direct government health insurance.
What's included in this industry?
Health and medical insurance policiesDental policies Pharmacy benefit management servicesCare between the health provider and individual recipient Administration of self-funded insurance plansHealth insurance premium investmentCompanies
Cvs Health CorporationUnitedhealth Group IncorporatedAnthem, Inc.Purchase this report to view all 11 major companies in this industry.
Related Terms
MANAGED CAREFULLY FUNDED INSURANCESELF-FUNDED INSURANCEPREFERRED PROVIDER ORGANIZATION (PPO)HEALTH MAINTENANCE ORGANIZATION (HMO)POINT-OF-SERVICE (POS)HIGH-DEDUCTIBLE HEALTH PLANINDEMNITY PLANMEDICAL LOSS RATIOIndustry Code
NAICS 524114 - Health & Medical Insurance in the US
Performance
Get an indication of the industry's health through historical, current and forward-looking trends in the performance indicators that make or break businesses.
Analyst insights
Consolidation will continue in the next couple of years. Smaller insurers don’t have the same power to take on increased costs stemming from regulation.
In this chapter (4)
- Current Performance
- Outlook
- Volatility
- Life Cycle
Key metrics
- Annual Revenue, Recent Growth, Forecast, Revenue Volatility
- Number of Employees, Recent Growth, Forecast, Employees per Business, Revenue per Employee
- Number of Businesses, Recent Growth, Forecast, Employees per Business, Revenue per Business
- Total Profit, Profit Margin, Profit per Business
Charts
- Revenue, including historical (2013-2022) and forecast (2023-2028)
- Employees, including historical (2013-2022) and forecast (2023-2028)
- Businesses, including historical (2013-2022) and forecast (2023-2028)
- Profit, including historical (2013-2023)
- Industry Volatility vs. Revenue Growth
- Industry Life Cycle
Detailed analysis
- Trends in supply, demand and current events that are driving current industry performance
- Expected trends, economic factors and ongoing events that drive the industry's outlook
- Key success factors for businesses to overcome volatility
- How contribution to GDP, industry saturation, innovation, consolidation, and technology and systems influence the industry's life cycle phase.
Products and Markets
Learn about an industry's products and services, markets and trends in international trade.
Analyst insight
Most revenue is generated from premiums that are related to fully funded insurance policies. Under this traditional form of coverage, the health insurer is responsible for pa...
In this chapter
- Products & Services
- Major Markets
Key metrics
- Largest market segment and value in 2023
- Product innovation level
Charts
- Products & services segmentation in 2023
- Major market segmentation in 2023
Detailed analysis
- Trends impacting the recent performance of the industry's various segments
- Innovations in the industry's product or service offering, specialization or delivery method
- Key factors that successful businesses consider in their offerings
- Buying segments and key trends influencing demand for industry products and services
Geographic Breakdown
Discover where business activity is most concentrated in an industry and the factors driving these trends to find opportunities and conduct regional benchmarking.
Analyst insights
Geographical distribution has changed little over the past decade. The distribution of health insurance is conducted on a state-by-state basis due to industry regulations.
In this chapter (1)
- Business Locations
Charts
- Share of revenue, establishment, wages and employment in each state
- Share of population compared to establishments in each region in 2023
Tables
- Number and share of establishments in each state in 2023
- Number and share of revenue each state accounts for in 2023
- Number and share of wages each state accounts for in 2023
- Number and share of employees in each state in 2023
Detailed analysis
- Geographic spread of the industry across North America, and trends associated with changes in the business landscape
- Key success factors for businesses to use location to their advantage
Competitive Forces
Get data and insights on what's driving competition in an industry and the challenges industry operators and new entrants may face, with analysis built around Porter's Five Forces framework.
Analyst insights
Reform pushes big insurers to get bigger. The healthcare reforms enacted in 2010 have been driving mergers and acquisitions, as insurers benefit from economies of scale and g...
In this chapter (4)
- Concentration
- Barriers to Entry
- Substitutes
- Buyer & Supplier Analysis
Key metrics
- Industry concentration level
- Industry competition level and trend
- Barriers to entry level and trend
- Substitutes level and trend
- Buyer power level and trend
- Supplier power level and trend
Charts
- Market share concentration among the top 4 suppliers from 2018-2023
- Supply chain including upstream supplying industries and downstream buying industries, flow chart
Detailed analysis
- Factors impacting the industry’s level of concentration, such as business distribution, new entrants, or merger and acquisition activity.
- Key success factors for businesses to manage the competitive environment of the industry.
- Challenges that potential industry entrants face such as legal, start-up costs, differentiation, labor/capital intensity and capital expenses.
- Key success factors for potential entrants to overcome barriers to entry.
- Competitive threats from potential substitutes for the industry’s own products and services.
- Key success factors for how successful businesses can compete with substitutes.
- Advantages that buyers have to keep favorable purchasing conditions.
- Advantages that suppliers have to maintain favorable selling conditions.
- Key success factors for how businesses can navigate buyer and supplier power.
Companies
Learn about the performance of the top companies in the industry.
Analyst insights
Major companies are adapting to the COVID-19 pandemic ending. After nearly 2 years of the world in turmoil, things are settling back to normal.
In this chapter
- Market Share Concentration
- Companies
- Company Spotlights
Charts
- Industry market share by company in 2019 through 2023
- Major companies in the industry, including market share, revenue, profit and profit margin in 2023
- Overview of Cvs Health Corporation's performance by revenue, market share and profit margin from 2017 through 2023
- Overview of Unitedhealth Group Incorporated's performance by revenue, market share and profit margin from 2017 through 2023
- Overview of Anthem, Inc.'s performance by revenue, market share and profit margin from 2017 through 2023
- Overview of revenue, market share and profit margin trend for 8 additional companies
Detailed analysis
- Description and key data for Cvs Health Corporation, and factors influencing its performance in the industry
- Description and key data for Unitedhealth Group Incorporated, and factors influencing its performance in the industry
- Description and key data for Anthem, Inc., and factors influencing its performance in the industry
- Description, key data and performance trends for 8 additional companies
External Environment
Understand the demographic, economic and regulatory factors that shape how businesses in an industry perform.
Analyst insights
Insurers are highly regulated and are subject to both state and federal regulatory agencies. The main source of regulation stems from state-level entities.
In this chapter
- External Drivers
- Regulation & Policy
- Assistance
Key metrics
- Regulation & policy level and trend
- Assistance level and trend
Charts
- Regulation & Policy historical data and forecast (2013-2028)
- Assistance historical data and forecast (2013-2028)
Detailed analysis
- Demographic and macroeconomic factors influencing the industry, including Regulation & Policy and Assistance
- Major types of regulations, regulatory bodies, industry standards or specific regulations impacting requirements for industry operators
- Key governmental and non-governmental groups or policies that may provide some relief for industry operators.
Financial Benchmarks
View average costs for industry operators and compare financial data against an industry's financial benchmarks over time.
Analyst insights
Expenses can be separated into two broad categories: costs directly related to medical care and other costs associated with running insurers' operations. The cost directly re...
In this chapter
- Cost Structure
- Financial Ratios
- Key Ratios
Key metrics
- Profit margin, and how it compares to the sector-wide margin
- Average wages, and how it compares to the sector-wide average wage
- Largest cost component as a percentage of revenue
- Industry average ratios for days' receivables, industry coverage and debt-to-net-worth ratio
Charts
- Average industry operating costs as a share of revenue, including purchases, wages, depreciation, utilities, rent, other costs and profit in 2023
- Average sector operating costs as a share of revenue, including purchases, wages, depreciation, utilities, rent, other costs and profit in 2023
- Investment vs. share of economy
Data tables
- Industry Multiples (2016-2021)
- Industry Tax Structure (2016-2021)
- Income Statement (2016-2021)
- Balance Sheet (2016-2021)
- Liquidity Ratios (2016-2021)
- Coverage Ratios (2016-2021)
- Leverage Ratios (2016-2021)
- Operating Ratios (2016-2021)
- Cash Flow & Debt Service Ratios (2013-2028)
- Revenue per Employee (2013-2028)
- Revenue per Enterprise (2013-2028)
- Employees per Establishment (2013-2028)
- Employees per Enterprise (2013-2028)
- Average Wage (2013-2028)
- Wages/Revenue (2013-2028)
- Establishments per Enterprise (2013-2028)
- IVA/Revenue (2013-2028)
- Imports/Demand (2013-2028)
- Exports/Revenue (2013-2028)
Detailed analysis
- Trends in the cost component for industry operators and their impact on industry costs and profitability
Key Statistics
Industry Data
Data Tables
Including values and annual change:
- Revenue (2013-2028)
- IVA (2013-2028)
- Establishments (2013-2028)
- Enterprises (2013-2028)
- Employment (2013-2028)
- Exports (2013-2028)
- Imports (2013-2028)
- Wages (2013-2028)
Methodology
How are IBISWorld reports created?
IBISWorld has been a leading provider of trusted industry research for over 50 years to the most successful companies worldwide. With offices in Australia, the United States, the United Kingdom, Germany and China, we are proud to have local teams of analysts that conduct research, data analysis and forecasting to produce data-driven industry reports.
Our analysts start with official, verified and publicly available sources of data to build the most accurate picture of each industry. Analysts then leverage their expertise and knowledge of the local markets to synthesize trends into digestible content for IBISWorld readers. Finally, each report is reviewed by one of IBISWorld’s editors, who provide quality assurance to ensure accuracy and readability.
IBISWorld relies on human-verified data and human-written analysis to compile each standard industry report. We do not use generative AI tools to write insights, although members can choose to leverage AI-based tools within the platform to generate additional analysis formats.
What data sources do IBISWorld analysts use?
Each industry report incorporates data and research from government databases, industry-specific sources, industry contacts, and our own proprietary database of statistics and analysis to provide balanced, independent and accurate insights.
Key data sources in the US include:
- US Census Bureau
- US Bureau of Labor Statistics
- US International Trade Commission
Analysts also use industry specific sources to complement catch-all sources, although their perspective may focus on a particular organization or representative body, rather than a clear overview of all industry operations. However, when balanced against other perspectives, industry-specific sources provide insights into industry trends.
These sources include:
- Industry and trade associations
- Industry federations or regulators
- Major industry players annual or quarterly filings
Finally, IBISWorld’s global data scientists maintain a proprietary database of macroeconomic and demand drivers, which our analysts use to help inform industry data and trends. They also maintain a database of statistics and analysis on thousands of industries, which has been built over our more than 50-year history and offers comprehensive insights into long-term trends.
How does IBISWorld forecast its data?
IBISWorld’s analysts and data scientists use the sources above to create forecasts for our proprietary datasets and industry statistics. Depending on the dataset, they may use regression analysis, multivariate analysis, time-series analysis or exponential smoothing techniques to project future data for the industry or driver. Additionally, analysts will leverage their local knowledge of industry operating and regulatory conditions to impart their best judgment on the forecast model.
IBISWorld prides itself on being a trusted, independent source of data, with over 50 years of experience building and maintaining rich datasets and forecasting tools. We are proud to be the keystone source of industry information for thousands of companies across the world.
Learn more about our methodology and data sourcing on the Help Center.
Frequently Asked Questions
Unlock comprehensive answers and precise data upon purchase. View purchase options.
What is the market size of the Health & Medical Insurance in the US industry in United States in 2024?
The market size of the Health & Medical Insurance in the US industry in United States is $1.3tr in 2024.
How many businesses are there in the Health & Medical Insurance in the US industry in 2023?
There are 840 businesses in the Health & Medical Insurance in the US industry in United States, which has grown at a CAGR of 2.0 % between 2018 and 2023.
Has the Health & Medical Insurance in the US industry in United States grown or declined over the past 5 years?
The market size of the Health & Medical Insurance in the US industry in United States has been growing at a CAGR of 3.6 % between 2018 and 2023.
What is the forecast growth of the Health & Medical Insurance in the US industry in United States over the next 5 years?
Over the next five years, the Health & Medical Insurance in the US industry in United States is expected to grow.
What are the biggest companies in the Health & Medical Insurance in the US market in United States?
The biggest companies operating in the Health & Medical Insurance market in United States are Cvs Health Corporation, Unitedhealth Group Incorporated and Anthem, Inc.
What does the Health & Medical Insurance in the US in United States include?
Health and medical insurance policies and Dental policies are part of the Health & Medical Insurance in the US industry.
Which companies have the highest market share in the Health & Medical Insurance in the US in United States?
The company holding the most market share in United States is Cvs Health Corporation.
How competitive is the Health & Medical Insurance in the US industry in United States?
The level of competition is high and steady in the Health & Medical Insurance in the US industry in United States.
