AMA: A look at concentration in commercial insurance, MA markets

Highly relevant to the impending US premium explosion, I pulled this one from the MHF RSS feed. Bold font inserted showing Michigan's dubious distinction.

The American Medical Society annually publishes this report, reliably calling out lack of competition in the insurance markets. (Their own stranglehold on clinical practice, not so much.)

Similarly, insurance lobbies may be depended upon to pinpoint hospital and pharma market abuses; and vice versa. Such is the stuff of health policy reform.

https://www.fiercehealthcare.com/payers/ama-look-concentration-commercial-insurance-ma-markets

AMA: A look at concentration in commercial insurance, MA markets

Paige Minemyer      |     Dec 17, 2025 

The study found that concentration in local commercial insurance markets has increased over the past decade. (Frankljunior/Getty Images)
The American Medical Association released its latest look at concentration in health insurance, with UnitedHealth, Elevance Health and Aetna leading the way in market share.

UnitedHealth Group held the largest individual share of the commercial market in 2024 at 16%, followed by Elevance and Aetna who both controlled about 12% of the market. Health Care Service Corp was the only Blues plan to crack the top 5 with a 6% market share, but if BCBS insurers were taken collectively, they controlled 43% of the commercial market.

Cigna rounded out the top five with a 9% market share, according to the report.

UnitedHealth also topped the list in Medicare Advantage, with a 30% market share. The remaining top five insurers in that space were Humana (19%), Aetna (12%), Kaiser Permanente (6%) and Elevance Health (5%).

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The study found that concentration in local commercial insurance markets has increased over the past decade. Based on federal guidelines, 97% of metro commercial insurance markets were concentrated in 2024 compared to 95% in 2014.

Concentration has declined, however, in Medicare Advantage, according to the report. Similar to the commercial space, 97% of MA markets were concentrated in 2024, down from 99% in 2017.

“In the vast majority of metropolitan areas across the country, health insurers hold outsized market share—leaving patients with fewer choices and higher costs,” said AMA CEO and Executive Vice President John J. Whyte, M.D., in a press release. “When one or two companies call the shots, premiums rise, options shrink, and patients suffer. Strengthening competition—not consolidation—is the path to lower costs and improved access.”

For the commercial market, 91% of metro areas saw one insurer control market share of at least 30%. In nearly half (47%) of regions, a single payer controlled at least 50% of the market share. Blue Cross Blue Shield plans held the largest market share across 84% of metro areas, per the study.

The five states with the lowest competition in the commercial space were Alabama, Kentucky, Hawaii, Michigan and Louisiana.

In MA, a single insurer held a 30% or more market share in 90% of regions, and in 24% of metro areas a single payer held market share of at least 50%.

UnitedHealth controlled the largest market share in 44% of metro areas for Medicare Advantage, with Humana having the largest share in 23% of regions. The five states with the least competitive markets in MA were Wyoming, the District of Columbia, Rhode Island, Montana and Nebraska.