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Report
United States Health And Medical Insurance - Market Share Analysis, Industry Trends & Statistics, Growth Forecasts (2025 - 2030)
Market Report I 2025-04-28 I 152 Pages I Mordor Intelligence
The United States Health And Medical Insurance Market size is estimated at USD 1.59 trillion in 2025, and is expected to reach USD 2.13 trillion by 2030, at a CAGR of greater than 6% during the forecast period (2025-2030).
The US healthcare system is characterized by high costs for individuals and the lack of universal coverage. The government takes steps to assist economically disadvantaged groups, such as the elderly, disabled, and underprivileged individuals, with healthcare expenses. Due to the absence of a nationwide health insurance system, most Americans rely on their employers for health insurance coverage, either through the employer's plan or by purchasing individual plans directly from insurers. In the market, private health insurance providers compete with each other to provide individuals and families with a variety of healthcare options.
Health insurance provided by employers is an important role to play in the provision of health care, as there are many employers offering healthcare benefits under their workers' compensation packages. This model allows for the sharing of premium costs between employers and employees, often through negotiated group rates with insurance companies. The individual health insurance market serves those without access to employer-sponsored plans or government programs like Medicare and Medicaid, offering plans through the Health Insurance Marketplace established by the Affordable Care Act, as well as directly from insurance companies.
The United States government participates in the health insurance sector through initiatives like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Medicare is mainly for individuals aged 65 years and above, while Medicaid and CHIP cater to low-income individuals and families. The Health Insurance Marketplace, also known as the Exchange, is an online application or platform where people can compare and buy health insurance plans from private insurers. These plans are grouped into metal levels (Bronze, Silver, Gold, and Platinum) based on coverage and cost-sharing. The US health insurance market post-COVID is experiencing a surge in demand and evolving coverage options.
In addition, the rising incidences of chronic diseases like diabetes, cancer, heart diseases, and neurodegenerative conditions are expected to boost the uptake of health insurance. The costs linked to treating chronic illnesses such as cancer and heart disease are notably high in the United States. As a result, many individuals opt for health and medical insurance to avoid the sudden financial strain of hefty hospital bills and other medical expenses.
United States Health And Medical Insurance Market Trends
The Online Channel is Expected to Witness New Growth Avenues in the Coming Future
The US health insurance market is experiencing significant growth in the online channel segment between 2024 and 2029. This can be attributed to the convenience of purchasing insurance policies online and the availability of guidance on discounts, offers, and plans provided by insurance companies. These factors enhance consumer confidence in online insurance purchases. The online segment is expected to witness rapid expansion due to the widespread use of the internet and smartphones, advancements in technology, changes in consumer purchasing behavior driven by digitalization, a wide range of insurance products available, and the abundance of discounts and offers on insurance websites. In order to streamline the insurance process, companies are using technology like artificial intelligence, chatbots, and machine learning. For example, AI enables health insurers to collect, analyze, and utilize large volumes of healthcare data to identify new business opportunities and optimize risk management. Additionally, AI can be integrated into insurance software to enhance medical billing while ensuring compliance with HIPAA regulations.
The Private Health Insurance (PHI) Segment is Expected to Fuel the Market Growth in the United States
Private health insurance plans in the United States generally fall into two categories, which include group health insurance and individual health insurance. Group health insurance is usually offered by employers to their employees and often provides coverage for dependents. Individuals and families can buy individual health insurance directly from insurance companies or through a health insurance marketplace.
Private health insurance plans vary in terms of their coverage and cost-sharing arrangements. They typically involve a combination of premiums, deductibles, co-payments, and co-insurance. The specific details of coverage and cost-sharing depend on the plan and the insurance provider. A variety of benefits and services, such as hospitalization, outpatient care, prescription drugs, preventive care, and mental health care, are offered by private health insurance plans. The extent of coverage varies among plans, and individuals should review their policy documents to understand what is covered. Private health insurance premiums can vary widely depending on factors such as age, location, plan type, and coverage level. The cost of private health insurance has been a concern for many Americans, and affordability remains a significant challenge for those who do not receive employer-sponsored coverage or qualify for government assistance programs. However, the increasing number of chronic diseases in the United States, including diabetes, colorectal cancer, heart disease, and degenerative diseases, is likely to lead to an increase in private health insurance enrollment. The costs associated with treating chronic conditions, such as cancer or heart disease, are extremely high in the United States. As a result, many people choose to purchase health insurance to avoid the sudden burden of large hospitals and other out-of-pocket costs.
United States Health And Medical Insurance Industry Overview
The US health insurance market is moderately consolidated. The increasing number of new players in the market is expected to increase the competition levels for the established market players. ? The rapid adoption of advanced technology for improved healthcare, as well as the introduction of new policies, are significant factors influencing the competitive nature. Furthermore, to gain market share, players are employing various strategies such as expansion, merger and acquisition, partnership, and collaboration.?Some of the key players operating in the market are UnitedHealth Group, Elevance Health, Cigna Group, HCSC Group, and Centene Corporation.
Additional Benefits:
- The market estimate (ME) sheet in Excel format
- 3 months of analyst support
1 INTRODUCTION
1.1 Study Assumptions and Market Definition
1.2 Scope of the Study
2 RESEARCH METHODOLOGY
3 EXECUTIVE SUMMARY
4 MARKET DYNAMICS
4.1 Market Overview
4.2 Market Drivers
4.2.1 Government Subsidized Health Insurance Schemes is Boosting the Sales of Health and Medical Insurance Policies
4.2.2 Aging Population in United States and increasing Healthcare Costs
4.3 Market Restraints
4.3.1 Rising Costs and Limited Coverage
4.3.2 Increasing Regulatory complexity
4.4 Market Opportunities
4.4.1 Innovative Digital Health Solutions
4.4.2 Merger and Acquisition with the Companies
4.5 Porter's Five Forces Analysis
4.5.1 Threat of New Entrants
4.5.2 Bargaining Power of Buyers/Consumers
4.5.3 Bargaining Power of Suppliers
4.5.4 Threat of Substitute Products
4.5.5 Intensity of Competitive Rivalry
4.6 Government Regulations and Initiatives
4.6.1 Brief on Patient Protection and Affordable Care Act (ACA) and its implications on the Overall Health Insurance Coverage
4.6.2 Insights on Latest Healthcare Policy Changes and their Effect on the Health Spending by US Citizens
4.7 Brief on Health Insurance Premiums and Study on the Effect of Medical Trend Rate on Health Plans
4.8 Insights on the Growing Online Sales of Health Insurance and the Growth Prospects in Health Insurance Sector
4.9 Technological Advancement and Innovation in Health Insurance Sector
4.10 The Impact of the COVID-19 Pandemic on the US health Insurance market
5 MARKET SEGMENTATION
5.1 By Procurement Type
5.1.1 Directly/individually Purchased
5.1.2 Employer-Based
5.1.2.1 Small Group Market
5.1.2.2 Large Group Market
5.2 By Products and Services Offered
5.2.1 Pharmacy Benefit Management
5.2.2 High Deductible Health Plans
5.2.3 Free-For-Service Plans
5.2.4 Managed Care Plans
5.3 By Place of Purchase
5.3.1 On Exchange
5.3.2 Off Exchange
6 COMPETITIVE LANDSCAPE
6.1 Market Concentration Overview
6.2 Company Profiles
6.2.1 UnitedHealth Group
6.2.2 Elevance Health
6.2.3 Cigna Group
6.2.4 HealthCare Services Group Inc.
6.2.5 Centene Corporation
6.2.6 Aetna Inc.
6.2.7 Kaiser Foundation Group
6.2.8 Independence Health Group
6.2.9 Molina Healthcare
6.2.10 Guidewell Mutual Holding
6.2.11 Humana
6.2.12 CVS Health*
7 FUTURE MARKET TRENDS
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