Payer Portrait

Founded by a physician in 1980 as a primary care clinic for low-income Californians, Molina Healthcare is now the fourth-largest Medicaid insurer in the U.S., serving more than 4 million lives. In addition to its Medicaid products, Molina also offers Affordable Care Act exchange plans in 16 states and is growing its Medicare Advantage (MA) business. The insurer in June unveiled a $600 million deal to acquire struggling insurtech Bright Health's California MA assets, which is expected to close in the first quarter of 2024. Molina has been on an acquisition spree of smaller, public sector-focused insurers in recent years. Other deals include its purchases of YourCare Health Plan, Affinity Health Plan, Magellan Complete Care, Senior Whole Health, Passport Health Plan and My Choice Wisconsin.

Humana Inc. is the sixth-largest health insurer in the U.S., serving more than 13 million lives nationwide. The insurer ranks No. 2 in Medicare Advantage (MA), behind UnitedHealthcare. Originally founded in the 1960s as a chain of nursing homes, the company has a long history in elder care, with more than 40% of its members enrolled in MA. Humana in 2021 unveiled a new direction for the company, introducing its payer-agnostic health care services division CenterWell. CenterWell's scope includes senior-focused primary care, home health and pharmacy benefits management. Humana in February 2023 said it will exit its commercial insurance markets and focus entirely on the public sector (Medicare, Medicaid and TRICARE), winding down its fully insured, self-funded and Federal Employee Health Benefit plans over the next 18 to 24 months.

Centene Corp. is the fourth-largest health insurer in the U.S., serving more than 21 million lives nationwide. The insurer ranks No. 1 in national managed Medicaid enrollment, holding contracts with 28 states. The insurer also dominates the Affordable Care Act (ACA) exchanges, leading the market with more than 3 million members in 27 states. The company is undergoing a multiyear value-creation program designed to control future administrative costs and focus on its core business — health insurance. In 2022, Centene sold two of its pharmacy businesses, Magellan Rx and PANTHERx Rare, in deals totaling $2.8 billion. The company in June 2023 divested Apixio, its artificial intelligence value-based care platform, to New Mountain Capital.

Founded in 1939 as a wave of prepaid insurance groups that later became Blue Cross and Blue Shield plans spread across the country, Blue Cross Blue Shield of Michigan (BCBSM) is now the largest insurer in the state of Michigan and the fifth-largest Blues affiliate in the U.S. Though its main focus is employer-sponsored commercial insurance products in its home state, BCBSM also offers Medicare Advantage (MA) plans nationwide. It consistently ranks among the top 10 national MA payers, making it unique among regionally focused Blues plans. Aside from Michigan, its largest MA markets are in Florida, Indiana and Vermont. BCBSM made waves in May 2023 when it struck a cashless "affiliation deal" with Blue Cross and Blue Shield of Vermont, which will place the Vermont Blues insurer under the BCBSM umbrella if approved by state regulators.

UnitedHealth Group's UnitedHealthcare is the largest insurer in the U.S., with membership approaching 50 million lives. In addition to health insurance, United's stalwart health services unit, Optum, powers pharmacy benefits management, specialty drug management, care delivery, population health services and data and analytics. United and Optum arguably set the trend toward increased payer integration, fueling a wave of consolidation that sparked CVS Health's purchase of Aetna, Cigna Corp.'s acquisition of Express Scripts and Elevance Health's launch of Carelon (then Anthem and IngenioRx). Optum in October 2022 completed its acquisition of Change Healthcare, giving the company unprecedented insight into patient, claims and outside payer data.

As the largest health insurance companies become increasingly diversified, Anthem, Inc., the second-largest insurer in the U.S., rebranded as Elevance Health in June 2022. In addition to its legacy insurance business, Elevance offers technology-enabled health care solutions, pharmacy benefits management, data analytics, behavioral health and population health management via Carelon, its health care services unit. Its various payer subsidiaries include Anthem Blue Cross Blue Shield, Amerigroup, WellPoint, Empire Blue Cross Blue Shield and MMM Healthcare. Elevance was founded in Indiana in 1946 as a mutual insurance company, eventually growing to become the largest Blue Cross and Blue Shield affiliate in the U.S. Gail Boudreaux has served as Elevance's CEO since 2017.

Independence Health Group is the parent company of Independence Blue Cross, the second-largest Blues insurer in Pennsylvania (behind Highmark Health), and AmeriHealth Caritas, a managed Medicaid payer serving more than 2.3 million beneficiaries in seven states and the District of Columbia. It also operates the AmeriHealth Insurance Company of New Jersey, a commercial payer serving about 209,000 members. Founded in 1938 as the Associated Hospital Service of Philadelphia, Independence now counts more than 4.5 million members across the spectrum of health insurance products. Still based in Philadelphia, it leads its home state’s individual, self-funded (administrative services only, or ASO) and managed Medicaid insurance markets. Optum’s FutureScripts serves as the primary pharmacy benefits manager for Independence Blue Cross. AmeriHealth Caritas, meanwhile, operates its own in-house PBM, PerformRx.

With more than 1 million members, Blue Cross and Blue Shield of Louisiana is the largest Blues affiliate in its home state and the second-largest insurer overall, behind UnitedHealthcare. Founded in 1934 as the Hospital Service Association of New Orleans, BCBSLA is now the 19th largest Blues insurer in the U.S. While the majority of its customers are employer groups, the insurer also offers coverage on the Affordable Care Act exchanges in Louisiana, as well as Medicare Advantage (MA) plans. It dominates Louisiana’s individual and group risk-based commercial markets, holding 88.5% and 74.5% of overall market share, respectively. Cigna Corp.’s Express Scripts currently serves as BCBSLA’s pharmacy benefits manager.

Cigna Corp. is the fifth-largest health insurer in the U.S., serving more than 15 million lives nationwide. Roughly 80% of its members are enrolled in administrative services only (ASO) contracting arrangements. While Cigna largely covers employer groups, the insurer is working to build its individual and Medicare Advantage (MA) businesses. The insurer will expand its Affordable Care Act exchange offerings to 50 new counties in Georgia, Mississippi and North Carolina in 2023 and add three new states — Indiana, South Carolina and Texas — to its market. Cigna currently ranks 12th in national exchange enrollment, with 307,500 members. In the MA arena, Cigna ranks 8th nationally. For the 2023 plan year, the company is expanding its MA plans to 106 new counties and two new states — Kentucky and New York.

Sanford Health Group is the health insurance unit of Sanford Health, a large, integrated nonprofit health system of 47 hospitals based in Sioux Falls, South Dakota. It is the second-largest insurer in both its home state and neighboring North Dakota and also has a presence in Iowa, Minnesota and Nebraska. Sanford largely serves the commercial health insurance markets, having a strong presence in both the North and South Dakota exchange markets. The majority of its members are enrolled in risk-based commercial insurance products. UnitedHealth Group’s OptumRx serves as Sanford’s pharmacy benefits manager and also facilitates most of its specialty pharmacy benefits.