Payer Portrait

Select Health is the wholly owned health insurance unit of Intermountain Healthcare, a Salt Lake City-based health system of 33 hospitals. Select Health is the largest insurer in Utah and also has a presence in Idaho, Nevada and Colorado. The majority of Select Health’s members are enrolled in commercial risk-based products, with the insurer holding a robust Affordable Care Act exchange presence in Utah and Idaho, leading both states' exchange markets. Select Health also holds a Medicaid contract in Utah and has expanded its Medicare Advantage presence in recent years. Intermountain successfully merged with Colorado system SCL Health in 2022 and spearheaded the founding of Civica Rx, a nonprofit generic drug manufacturer that focuses on drugs in short supply or those with high mark-ups.

CVS Health Corp.’s Aetna is the third-largest health insurer in the U.S., serving more than 25 million lives across all market sectors. Nationally, Aetna ranks No. 3 in administrative services only (ASO) non-risk contracting, No. 4 in the group risk commercial market and No. 3 in Medicare Advantage (MA). Under CVS's banner, Aetna has been at the forefront of the industry's movement toward increased payer, PBM and provider integration. But 2024 has been a tough year for the insurer, fueled by higher-than-expected medical costs, particularly in the public sector, and earnings underperformance. CVS is reportedly considering breaking up its enterprise into separate businesses, partially due to Aetna's poor performance. The company in October appointed David Joyner, then president of CVS-owned PBM Caremark, as CEO, ousting former Aetna president Karen Lynch.

Founded in the 1930s by a Washington, D.C.-based hospital association, CareFirst BlueCross BlueShield is now one of the largest insurers in the Washington metropolitan area, leading the Maryland market and earning the No. 2 spot in the District. It largely offers commercial health products, including plans sold on the Affordable Care Act exchanges in D.C., Maryland and Virginia, as well as Medicare Advantage and Medicaid plans in Maryland. The insurer is relatively new to the public sector — it began offering MA products for the first time in 2021 and entered the Medicaid space via its 2020 acquisitions of Trusted Health Plan and the University of Maryland Medical System's Health Partners. CareFirst later lost its D.C. Medicaid contract in 2022, following a hotly contested bidding process. CareFirst is also the second-largest participant in the Federal Employee Health Benefits Program, behind Elevance Health, with about 635,000 members.

L.A. Care Health Plan is the largest publicly operated health plan in the United States, serving more than 2.5 million members in Los Angeles County. It largely serves Medi-Cal, the state's managed Medicaid program, but also offers products on California's state-based health insurance exchange, Covered California. In 2022, the insurer launched a Dual Eligible Special Needs Plan (D-SNP) that coordinates both Medicare and Medi-Cal benefits. Additionally, its PASC-SEIU Homecare Workers Health Care Plan is specifically designed for Los Angeles residents working as in-home caregivers. Most recently, L.A. Care in August 2024 cut 24% of its prior authorization codes to help avoid delays in member care and speed up inpatient discharge requests.

UPMC Health Plan is the health insurance unit wholly owned by the University of Pittsburgh Medical Center. UPMC operates a large health system of 40 hospitals throughout Pennsylvania and Appalachian regions of New York and Maryland, as well as several international locations. Its health plans serve members across the spectrum of insurance products, including Pennsylvania’s managed Medicaid program and the Affordable Care Act exchanges. It is currently the third-largest insurer in its home state and the fourth-largest integrated insurer in the U.S. UPMC also operates a Program of All-Inclusive Care for the Elderly, Community LIFE, and is a joint owner of Maryland Physicians Care, a provider-sponsored managed Medicaid plan.

Priority Health is the health insurance arm of Corewell Health, the Grand Rapids, Mich.-based nonprofit health system of 22 hospitals formed by the merger of Spectrum Health and Beaumont Health. It is the second-largest health insurer in Michigan, behind Blue Cross Blue Shield of Michigan, serving members across the spectrum of insurance products, including Michigan’s managed Medicaid program and the Affordable Care Act exchanges. Priority Health will expand its reach to Indiana and Ohio with its planned acquisition of Physicians Health Plan of Northern Indiana, a small nonprofit insurer serving the employer group markets.

The Lifetime Healthcare Companies are the parent organization of New York-based Blues insurer Excellus Blue Cross Blue Shield and Univera Healthcare. Combined, the companies are the sixth-largest insurer in New York, largely focusing on the Western and upstate New York markets. Lifetime on May 22 unveiled plans to acquire Capital District Physicians' Health Plan, Inc. — better known as CDPHP — a physician-founded nonprofit payer based in Albany, N.Y., that serves about 375,000 members. It offers employer group products and Medicare Advantage plans, and holds a New York Medicaid contract. CDPHP also operates ConnectRx, a community-based full-service pharmacy.

Founded in 2014, Clover Health is a Medicare Advantage-focused startup insurer that has grown to serve nearly 80,000 members across five states. The insurtech focuses on "physician enablement," empowered through its software platform, Clover Assist. Clover Assist aggregates patient data to support provider decision-making and identify early areas of intervention in patients with chronic diseases. Like its fellow insurtechs, Clover has struggled financially since becoming a publicly traded company, though it shows signs of achieving profitability as early as year-end 2024.

Founded in Dayton, Ohio, in 1989, CareSource is a not-for-profit health insurer that serves Medicaid, Medicare-Medicaid dual eligibles and Affordable Care Act (ACA) exchange members in six states, though Ohio remains its largest market. The insurer in recent years has faced a rocky road growing its Medicaid presence — it lost out on an Iowa contract, and its successful bid in Mississippi is held up by a legal standoff. CareSource has a pending Medicaid bid in Kansas but may be looking to the exchanges for faster expansion. The insurer in February struck an affiliation deal with Brookfield, Wis.-based Common Ground Healthcare Cooperative, one of the few remaining ACA CO-OP plans, which are governed by their members. Common Ground currently serves about 60,000 members.

Canton, Mass.-based Point32Health was established Jan. 1, 2021, following the successful merger of Harvard Pilgrim Health Care and Tufts Health Plan, two major players in the New England health insurance markets. With more than 1.5 million members, Point32Health is one of the largest insurers in New England, serving members across the spectrum of insurance products. The org’s top state market is Massachusetts, where it is the second-largest insurer overall, behind UnitedHealthcare. The insurer in February 2024 unveiled plans to acquire Baystate Health's insurance subsidiary, Health New England. The deal would grow Point32Health’s membership by 11%, to more than 1.7 million lives, according to AIS's Directory of Health Plans.