Health insurance markets lack competition, AMA reports

UnitedHealthcare is the largest insurer in both the commercial and Medicare Advantage markets with 51.3 million members, while Blue Cross and Blue Shield companies collectively have the largest geographic footprint.

Elevance Health, formerly Anthem, is the largest insurer by market share in 82 of 383 metro areas, according to the study. Health Care Service Corp.. which sells Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, is the second-largest and Florida Blue came in third. 

None of the insurers immediately responded to interview requests except UnitedHealthcare, which referred questions to the health insurance trade group AHIP, which did not respond to an interview request.

Although the health insurance exchanges were the least competitive overall, market share has varied the most in this product line over time, and smaller insurers have enticed significant numbers of members away from larger carriers.

Elevance Health’s exchanges market share dropped from 14% in 2014 to 4% in 2021 as it went from being the largest player by membership to the sixth-largest. Insurtechs Bright Health Group and Oscar Health, meanwhile, cracked the top 10 the first time last year, although both plan to shrink their exchange footprints for 2023.