Increasing Market Concentration in Health Insurance: 2025 Report Insights

The American Medical Association's 2025 report highlights increasing market concentration in the commercial health insurance industry. Evaluating 384 metropolitan areas, all U.S. states, and D.C., the report reveals compelling trends affecting industry professionals. By 2024, 97% of commercial health insurance markets at the metropolitan level exhibited high concentration, compared to 95% in 2014.

In nearly half of these areas, a single insurer dominated with over 50% market share, while the majority saw at least one carrier commanding 30% or more. UnitedHealth Group, Elevance Health, and CVS/Aetna stood out as top national commercial insurers with respective market shares of 16%, 12%, and 12%. Blue Cross Blue Shield companies collectively captured a 43% national commercial share, leading in 43 states and 84% of metropolitan regions.

States like Alabama and Kentucky were identified as having minimally competitive insurance markets. The Medicare Advantage (MA) segment also showcases high concentration, though this has slightly decreased since 2017. UnitedHealth Group leads the MA sector with a 30% share, followed by Humana and CVS/Aetna, with UnitedHealth commanding the largest MA market share in 44% of the metro areas assessed.

Centene's influence in ACA exchanges has escalated, achieving a 20% market share in 2024. These findings underscore the dominance of key insurers, suggesting strategic considerations for stakeholders focusing on growth and market positioning. The patterns of concentration may result in increased regulatory scrutiny, impacting competition strategies within both the commercial and MA segments. Industry participants must continue monitoring these developments to assess implications for compliance and risk management.