Who insures America?

Top 9 companies that insure America

Some people would say UnitedHealth Group is the largest insurer in America.   As a single entity they have the largest revenue of all companies.  They are not just a health insurance company.

They are also a health care service provider.  Around 25 million American receive health insurance through their division called UnitedHealth Care.

BlueCross BlueShield is by far the largest provider of health insurance in America.  However, BlueCross BlueShield is not a single company.  It currently consists of 36 separate entities. Together they insure more than 106 million Americans.

UnitedHealth Group

UnitedHealth Group, one of the largest and most diversified health insurance companies in the United States. It sells not only health insurance but provides health care services.   It recently announced plans to acquire Surgical Care Affiliates, a chain of outpatient surgery centers, for about $2.3 billion.  The deal is meant to further diversify their revenue stream away from insurance policies and more toward provider of services.

UnitedHealth Group is based in Minnetonka, Minnesota.   Their annual revenues for 2016 were around $180 billion dollars.  They offer products and services through two operating businesses, United HealthCare and Optum.   Optum is also referred to as OptumCare.  OptumCare  competes with Tenet Healthcare and  Hospital Corporation of America (HCA). 

United HealthCare covers around 40 million Americans and contributes close to 65% of UnitedHealth Group’s revenue.

Blue Cross and Blue Shield

Blue Cross and Blue Shield insurance companies are licensees of the Blue Cross Blue Shield Association (BCBSA).  There are currently 36 separate entities.

The companies are independent of the association and traditionally of each other, offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every US state.

♦ BCBS currently provides health insurance to more than 106 million Americans. 

They also act as administrators of Medicare in many states or regions of the US and provide coverage to state government employees as well as to the federal government employees under a nationwide option of the Federal Employees Health Benefit Plan.

Blue Cross was founded in 1929, and became the Blue Cross Association in 1960, while Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948.  

♦ Originally Blue Cross provide coverage for hospital services while Blue Shield provided coverage for physician services.  The two organizations merged in 1982.

Prior to 1986, organizations administering BCBS were 501(c) non-profits.  The Tax Reform Act of 1986 revoked most of their tax exemptions and they became 501(m) organizations, subject to federal taxes, but entitled to "special tax benefits."

In 1994, BCBS changed to allow its licensees to be for-profit corporations. BCBS today is a mix of nonprofit and for-profit organizations.

Health Care Services Corporation (HCSC) a BCBS licensee is the largest nonprofit health insurer in the country.  It concentrates its operations in Illinois and Texas.  It is the 4th largest health insurer in the US overall, it serves nearly 15 million members.

Anthem, Inc. is the largest for-profit BCBS company.  Anthem reported an operating revenue of $78.4 billion at the end of 2016.   It’s health plans can be found in fourteen states scattered around the country.  It also participates in Medicaid programs in twenty states.  It has 40 million members.

Anthem wants to merge with Cigna but the courts have ruled that such a merger would violated federal antitrust laws.   Anthem may appeal but most analyst doubt they can win this one without divesting more than they would like.

Aetna

Aetna Inc. was founded in 1853.   Headquartered in Hartford, Connecticut, U.S., Aetna reported $60 billion in revenues for 2015 with operating income of $2.7 billion.  It is considered the third largest insurer in America.

The company offers health care, dental, pharmacy, group life, disability, and long-term care insurance plans.  In total they serve about 46.3 million people of which 23.5 million are enrolled in medical policies.  The company has a market value of $41 billion.

Aetna acquired Coventry Health Care, Inc. on May 7, 2013 for $37 billion.   This acquisition helped Aetna become the third largest health care benefits company in America based on membership.

In 2015, Aetna announced they would buy Humana Inc. for $37 billion in cash and stock.  The merger was blocked by the courts.  Aetna threw in the towel on that one along with $1 billion in breakup fees to Humana.

December 03, 2017 — CVS Health announced that it had agreed to buy Aetna for about $69 billion in a deal that would combine the drugstore giant with one of the biggest health insurers in the United States.  This deal has the potential to reshape the nation’s health care industry.

Humana Inc.

Humana is a managed health care corporation that was founded 55 years ago.   It had revenues of $54 billion in 2015 with a net profit of $1.27 billion.   Aetna and Humana tried to merger but the courts objected.  Humana could receive around $1 billion in breakup fees if the deal falls through. 

Humana Inc. is a for-profit company based in Louisville, Kentucky.  Humana has over 13 million customers in the U.S.   Humana’s Medicare Advantage membership is about 3.19 million (17% of the market), which makes it an attractive target for other companies looking to expand in the Medicare market.

Kaiser Permanente

Kaiser Permanente is an integrated managed care consortium.  Under most situations members receive care within the Kaiser family of service providers.  Kaiser is based in Oakland, California.  It was founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield.  

Kaiser Permanente is one of the nation’s largest nonprofit health insurers, serving more than 11.3 million members.   In 2015, Kaiser had close to $61 billion dollars in revenue. Kaiser is comprised of three entities.

• Kaiser Foundation Hospitals and their subsidiaries

• Kaiser Foundation Health Plan, Inc.

• The Permanente Medical Groups.

Kaiser Permanente is regional.  Kaiser serves:

Northern & Southern California

Colorado

Georgia

Hawaii

Mid-Atlantic States (VA, MD, DC)

Northwestern (Oregon / Washington)

Cigna

Offers a number of health and life insurance products worldwide.  It operates in 30 countries. It sells medical, dental, vision, disability, life and accident insurance and related products and services.  The majority of its products are offered through employers.

Cigna also offers Medicare and Medicaid products and health, life and accident insurance coverages to individuals. 

Cigna had $38 billion revenue in 2015.  It has 15 million global medical customers.   It is unclear just how any Americans are covered by their health plans.  Cigna has had a rather tarnished past.  It has been involved in a number of court battles over  refusing to cover procedures that many of their competitors were covering at the time.  In 2011, the CNA determined that Cigna denied roughly 39.6% of all claims  —  compared to competitors such as Aetna who denied about 5.9% of all claims in the same time frame.

In the fall of 2011, Cigna agreed to buy HealthSpring Inc. for $3.8 billion.  This acquisition gave Cigna a big boost in Medicare plans going from 46,000 Medicare Advantage members to 400,000 members. 

In 2016,  Anthem tried to buy Cigna for $50 billion but the courts said no.  Anthem would like to appeal and Cigna would like to like to walk away with a hefty breakup fee.

Centene Corp

Centene Corp operates  in  two segments:  Managed Care and Specialty Services. The company has been in the healthcare business since 1984 and reported $22.7 billion in annual revenues in 2015.

It has over 13,000 employees with a market value of $10.9 billion.   In 2016, the company merged with HealthNet with a total transaction value of $6 billion.  It serves 11 million people.

WellCare Health Plans

WellCare Health Plans, Inc.  is based in Florida.  It was founded in 1985.  The company has 6,000 employees and serves over 4 million people.   The company is mainly involved with public healthcare plans such as Medicaid and Medicare.  It had revenues of $13.9 billion in 2015  and a market value of $6.5 billion.

Molina Healthcare

Molina Healthcare, Inc.  was started in 1980 by David Molina who worked as a physician in Long Beach, California.   Molina  had revenues of $14 billion in 2015.  Its coverage area consists of 10 US states and Puerto Rico.  It focuses of providing Medicaid-related solutions for low-income families and individuals.  Because of the areas and people it serves it doesn’t generate huge profits, around $143 million in 2015.

Molina is one of three major players in Medicaid health plans for the poor and Medicare Advantage coverage for the elderly.  The other two are Centene and WellCare.