UnitedHealthcare (UHC), the health insurance unit of UnitedHealth Group, Inc., is the largest health insurer in the U.S., offering products across all sectors. Nationally, UHC is the top insurer in the group risk, administrative services only (ASO) and Medicare Advantage (MA) markets. As of March 2021, United controls a whopping 26.7% of the national MA market, and has expanded its presence significantly year over year since 2018.
Anthem, Inc. is the second-largest health insurer in the U.S., serving more than 33 million lives nationwide. It is also the largest Blue Cross and Blue Shield affiliate, acting as a Blues licensee in 14 states. Anthem's in-house PBM unit, IngenioRx, manages most of its pharmacy benefits, though CVS Specialty Pharmacy serves as its specialty PBM vendor. Anthem also operates Anthem Behavioral Health, and completed an acquisition of Beacon Health Options, one of the largest independent providers of behavioral health services in the U.S., in May 2020.
Cigna Corp. is the fifth-largest health insurer in the U.S., serving more than 15 million lives nationwide. More than 80% of its members are enrolled in administrative services only (ASO) contracting arrangements. While Cigna largely covers employer groups, the insurer is working to expand its individual and Medicare Advantage (MA) business, bringing its Affordable Care Act exchange plans to 79 new counties in 2021 while also expanding its MA reach to 80 new counties for the 2021 plan year. The push to expand into these markets may be partially fueled by the nationwide job losses caused by the COVID-19 pandemic, as Cigna's overall membership is down 8.7% from 4Q19.
Centene Corp. is the fourth-largest health insurer in the U.S., serving more than 20 million lives nationwide. About 70% of Centene's members are enrolled in public-sector health insurance products. Nationally, the company is No. 1 in managed Medicaid, holding contracts with 26 states (see map below). The insurer also dominates the Affordable Care Act exchanges, leading the national market with 2.2 million members in 20 states. In Sept. 2020, Centene unveiled plans to expand its exchange products to two new states, Michigan and New Mexico, plus 400 new counties in its existing markets for the 2021 plan year.