With over $1.7 trillion in annual net premiums written, the U.S. insurance market is the largest in the world. Understanding which companies dominate this landscape is essential—not just for consumers, but for policymakers, legal professionals, and researchers.
The biggest insurance companies in the United States wield significant influence over claims processes, policy terms, and lobbying efforts that shape the broader financial system.
This guide ranks the largest insurance companies in the U.S. by direct premiums written and market share, examining how their decisions impact policyholders and the broader consumer economy.
Key Takeaways
- State Farm, GEICO (owned by Berkshire Hathaway), and Progressive lead in personal lines insurance, including auto and homeowners’ policies.
- UnitedHealth Group and Anthem (Elevance Health) dominate the health insurance sector.
- The biggest insurance companies in the United States set industry standards not only for claims handling and underwriting but also for legislative influence and market consolidation.
- Large insurers significantly influence state and federal insurance regulations through substantial lobbying efforts, often blurring the distinction between necessary premium adjustments and profit-driven motives.
- Premium increases by major insurers create ripple effects that extend beyond policyholders, contributing to higher costs for everyday goods and services as businesses absorb and pass along the higher commercial insurance expenses.
- Market concentration can reduce consumer choice, lead to more frequent claim denials or delays, and escalate systemic risks in disaster-prone regions.
How Insurance Companies Are Ranked
Insurance companies are typically ranked using three main metrics:
1. Direct Premiums Written
This refers to the total value of premiums collected for policies issued during a given year. It is the most commonly used benchmark because it reflects the company’s actual business volume.
2. Total Assets
Asset size indicates financial strength and reserves, which are particularly important for life and health insurers that manage long-term risk portfolios.
3. Market Share by Sector
Different companies dominate different sectors:
- Auto & Home Insurance: State Farm, GEICO, Progressive
- Health Insurance: UnitedHealth Group, Centene, Anthem
- Life Insurance: MetLife, Prudential (not in top 10 by premiums, but major in life insurance assets)
Top 10 Largest Health Insurance Companies in the United States (2023)
Based on direct premiums written, according to the NAIC 2023 Market Share Report:
| Rank | Company Name | Direct Premiums Written (2023) | Market Share |
| 1 | UnitedHealth Group | $248.88 billion | 16.37% |
| 2 | Elevance Health (Anthem) | $107.65 billion | 7.08% |
| 3 | Centene Corporation | $102.71 billion | 6.76% |
| 4 | Humana Inc. | $100.52 billion | 6.61% |
| 5 | CVS Health (Aetna) | $97.76 billion | 6.43% |
| 6 | Kaiser Foundation Group | $94.12 billion | 6.19% |
| 7 | Health Care Service Corp. (HCSC) | $55.50 billion | 3.65% |
| 8 | Cigna Health Group | $40.10 billion | 2.64% |
| 9 | Molina Healthcare Inc. | $30.94 billion | 2.04% |
| 10 | GuideWell Mutual Holding Group | $28.97 billion | 1.91% |
Industry Trends: Market Concentration and Consumer Impact
The dominance of the top 10 insurance companies raises important considerations:
Claims Handling Practices
Large insurers often set the tone for claims practices across the industry. Policyholders may face challenges when navigating claims with powerful companies that control significant market segments.
Consumer Choice
While competition remains in some sectors, market concentration can limit consumer options, particularly in areas such as health insurance, where a few providers dominate specific regions.
Bad Faith Concerns
Market leaders are frequently involved in litigation over delayed or denied claims. Policyholders must understand their rights and legal options when dealing with unfair claim denials.
How Large Insurance Companies Influence Legislation and Claims Practices
The biggest insurance companies in the United States don’t just dominate the market; they also play a significant role in shaping legislation, regulatory policy, and claims practices.
Premium Increases and Coverage Decisions
In the aftermath of the California wildfire crises, State Farm filed for significant premium increases and announced it would stop writing new homeowners’ policies in high-risk areas. While such rate hikes can be a legitimate response to mounting reinsurance costs and increased climate-related risks, they also raise broader concerns about the ripple effects on consumers.
Premium increases don’t just affect the cost of coverage—they can lead to reduced policy availability, force homeowners into state-backed insurance pools, or price some consumers out of coverage entirely. Additionally, these rate hikes create downstream effects across the broader economy.
As businesses absorb higher commercial insurance costs, they often pass these expenses onto consumers through increased prices for everyday goods and services. While some premium adjustments are justified responses to legitimate market pressures, such as rising reinsurance costs or climate-related risks, it is often difficult to disentangle these from decisions driven primarily by profit incentives.
These complexities underscore the significant influence large insurers wield in shaping state-level insurance availability, affordability, and even the cost of living.
Claim Denial Rates and Industry Trends
According to the 2024 Weiss Ratings report, denial rates for homeowners’ insurance claims have nearly doubled since 2004, rising from 25.8% to over 41.9% nationwide. In some states, such as Louisiana, the rate exceeds 44%.
These shifts reflect broader industry trends where large insurers increasingly prioritize profitability, often at the expense of consumer payouts.
Lobbying and Legislative Influence
Top insurance companies spend millions annually on lobbying efforts to influence state and federal laws. The insurance industry is one of the largest lobbying sectors in the United States, routinely spending hundreds of millions of dollars each year.
This financial clout enables insurers to advocate for regulatory changes that favor their interests, lobby against stricter penalties for bad faith, and influence disaster response frameworks to minimize corporate liability.
Impact on Policyholders
The consolidation of power among a few large insurers can result in:
- Fewer consumer protections
- Increased premium rates
- More frequent claim denials or delays
- Reduced competition, especially in disaster-prone regions
Understanding this dynamic is crucial for both consumers and policymakers, especially when evaluating industry practices and advocating for fair claims handling.
How Premiums Shape Consumer Spending and Economic Stability
Rising insurance premiums, particularly in the health sector, have far-reaching consequences for household finances and the broader economy.
Health Insurance Affordability and Financial Pressure
According to the Kaiser Family Foundation (KFF), nearly 40% of insured adults under 65 worry about affording their monthly premiums, and more than 60% fear unexpected medical bills. Many respondents reported delaying or skipping medical care due to costs, which negatively impacts both personal health outcomes and workforce productivity.
Economic Ripple Effects
When consumers face rising premium burdens, they tend to allocate less of their budget to non-healthcare essentials, such as housing, food, and transportation. This shift suppresses consumer-driven economic growth. The impact is especially significant among middle-income households, where healthcare premiums are consuming a growing share of disposable income.
Macroeconomic Risks Identified by Investors
A 2025 report by the Interfaith Center on Corporate Responsibility (ICCR) warns that UnitedHealth Group’s restrictive practices—such as high deductibles and claim denials—may contribute to macroeconomic instability. These tactics discourage timely care, increase long-term costs, and reduce labor force participation due to unmanaged chronic illness and financial strain.
The Bottom Line: Why Understanding the Largest U.S. Insurance Companies Matters
Efficient and fair insurance provision is an integral part of a functioning, modern society. However, the biggest insurance companies in the United States must be continuously scrutinized to ensure they do not prioritize profits over fair and ethical conduct.If you’ve suffered financial harm because of unfair claim denials, or other insurance company tactics that put profit over people, Daly & Black, P.C. is here to help. Reach out to learn how we can fight for the justice and compensation you may be owed.