Who are the biggest, best, safest and most reliable health insurance carriers in the US? After extensive and exhaustive research, we have the results! Our 2024 ratings and reviews are available to help you choose a top-ranked company that provides affordable pricing and comprehensive on and off-Marketplace coverage. Typically, single, family, self-employed, Senior Medicare, and small-business options are offered. Non-subsidized and off-Exchange plans are also available. Our Top-10 list is shown below.
Several of the factors used in determining rankings include size, stability, ratings, promptness of paying claims, plan availability, competitiveness of prices, ease of customer service and broker assistance, online enrollment process, and size of local and national provider networks. In recent years, the number of available providers has dwindled, so having access to physicians, hospitals, and other medical facilities is more important than in past years.
Also, many carriers, such as UnitedHealthcare, Humana, and Aetna, have ceased writing Exchange business in many states. Although they offer Medicare (Supplement, Advantage, and Part D) and Group plans, Marketplace options from these carriers are not often not widely available.
UnitedHealthcare returned to selected states for the most recent Open Enrollment. It's also possible that several insurers, such as Kaiser and Cigna, will offer 2024 plans in additional states. If individual states are permitted to customize plans for their residents, additional policies will be introduced, with newer and more flexible benefits. Marketing and selling plans across state lines may also become available.
When purchasing benefits during Open Enrollment, your pre-existing conditions are covered without paying a higher premium, or waiting for any benefits to begin. Your eligibility for a federal subsidy will determine how much your rate reduces and which cost-sharing features will apply. However, quality "off-Marketplace" plans are also available for persons that prefer as little government involvement as possible. Often larger provider-networks and streamlined enrollment are common with these options. Comprehensive and catastrophic options are offered.
Senior Medigap plans are not eligible for federal subsidies and have a separate Open Enrollment period (October 15-December 7). When applicants reach age 65 and are Medicare-eligible, a separate enrollment period is created. When you first become eligible, a 7-month enrollment period is available for Parts A and B signup. By waiting until the month you reach age 65 to sign up, Part B benefits may be delayed. There is no law or obligation that requires any person to elect Medicare Supplement coverage.
Anthem
Part of the Blue Cross and Blue Shield Association, Anthem was created 20 years ago when it merged with Wellpoint Health Networks, and instantly became the largest US health insurer. Although it eventually lost that top spot to UnitedHealthcare, it is still the biggest for-profit managed care company in BCBS. Officially, the branded name reverted back to "Anthem" four years ago. Based in Indianapolis, several "customer segments" provide diversified coverage. These segments include Individual, Medicare, Medicaid, Blue Card, Federal Employee Program, National Accounts, Local, and Specialty Products.
Cigna and Anthem were previously in the process of merging their $54 billion of assets, although completing the transition never occurred. A federal judge also blocked the merger, after the US Justice Department filed suit in several states. Violation of antitrust laws was the main reason that the merger was denied. Humana probably will not be a takeover target in the future, although both carriers offer competitively-priced Senior products in all states. Medicare Advantage and Part D plan portfolios are often takeover targets, especially when about 12% of all Americans are covered with an Anthem affiliated policy.
Based in the Midwest (Indianapolis), Wellpoint offers all types of health insurance, including, HMOs, EPOs, PPOs, HSA Accounts, short-term plans, student medical coverage, and of course, Exchange/Marketplace contracts. In addition to medical plans, also available are specialty products such as life, disability, dental, vision, flexible spending accounts (FSAs), group retiree solutions (GRS), and long-term care. Senior products include Supplement, Advantage, and Part D prescription drug plans. Anthem rates in Ohio and other Midwestern states are very competitive and usually are among the lowest prices available.
Currently, they offer Marketplace plans in 14 states (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia, and Wisconsin. . Anthem returned to Ohio five years ago, offering coverage in 25 counties. Popular private individual/family plans include Bronze Pathway X HMO 9450, Bronze Pathway X HMO 6000, Bronze Pathway X HMO 5500, Bronze Pathway X HMO 7500/50%/Standard, Bronze Pathway X HMO 7450/0% for HSA, and Silver Pathway X HMO 5900/40% Standard. Anthem/BGCA serves a youth population with more than 4,000 US locations and additional military installations.
Because of the huge nationwide provider network, customers are often able to take advantage of services that are "repriced" due to contractual agreements. This often results in discounts up to 75% (especially for lab tests and diagnostic services) that save patients thousands of dollars in out-of-pocket expenses. Costs of MRIs, CT Scans, ER visits, and other expensive procedures are also helped by these agreements. Large hospital bills result in the largest savings.
Medicare Advantage plans include Extra Help, Full Dual Advantage, Medicare Advantage HMO, Medicare Advantage PPO, Medicare Advantage Regional PPO, Medicare Advantage 2, Medicare Advantage 3 HMO, Medicare Advantage 3 PPO, and Veteran.
Senior services are heavily emphasized by Anthem Medicare Supplement and Medicare Advantage plans. Medigap coverage is available outside of standard Open Enrollment periods if you reach age 65. They recommend that older adults routinely receive the following screenings: BMI (Body Mass Index), diabetes, hypertension, cholesterol, fall prevention, osteoporosis, and colon cancer. Since preventative expenses are fully covered on Senior and under-65 plans, out-of-pocket expenses are typically extremely low or $0.
Some of its biggest brand name affiliated companies include Blue Cross, Blue Cross Blue Shield (BCBS), Empire Blue Cross, Anthem, Amerigroup, UniCare and CareMore. Additional companies that offer related services include DeCare Dental, Golden West Dental, Resolution Health, Meridian Resource Company, and National Government Services. Anthem is also involved in low-income household coverage, including Medicaid and State Children's Health Insurance programs (CHIP). One of the most recent major acquisitions was Health Sun, an integrated Medicare Advantage Health Plan in Florida. Federal Employee Program (FEP) coverage is offered to US Government workers and dependents.
BCBS (see above) companies include Rocky Mountain Hospital and Medical Service (Nevada and Colorado), Anthem Health Plans (Connecticut), BCBS Healthcare Plan of Georgia (Georgia), Anthem and Community Insurance (Ohio and Indiana), Anthem Plans of Kentucky (Kentucky), Anthem Plans of Maine (Maine), Anthem BCBS (Missouri), Anthem Plans of New Hampshire (New Hampshire), Anthem Health Plans of Virginia and HealthKeepers (Virginia), and BCBS of Wisconsin (Wisconsin).
UnitedHealthcare Features A Large Portfolio Of Plans
UnitedHealthcare
UnitedHealthcare is the insurance wing of UnitedHealth Group, the largest writer of coverage in the US. Currently, more than 70 million persons are covered and the provider network consists of more than 1.3 million physicians, specialists and other related professionals. Also, 6,500 hospitals are "in-network" along with more than 80,000 dentists and eye wear-related providers. Either individual, group, or Senior products are offered in every state. UHC also offers coverage in 130 additional countries and is recognized as a "Most Admired Company" by Fortune.
Plans are marketed to the single, family and small business marketplace. Previously, millions of grandfathered plans remained in-force, providing quality benefits at a reasonable rate. However, most of those contracts were updated or re-issued to comply with federal regulations. Typically, prices are among the most competitive of all companies in most urban and rural areas. "Short-term" policies remain very popular, and although these plans do not meet Affordable Care Act guidelines, they are very inexpensive and are usually issued within 24 hours.
Different variations of temporary plans are available, including copay policies that cover pcp office visits and prescription drugs. $2 million of coverage is available for temporary plans. Depending upon the state, coverage is available from 1-36 months. Pre-existing conditions are not covered, but the low premiums provide an affordable choice for persons that missed the Open Enrollment deadline. Dental, vision, critical-illness, and supplementary accident benefits can be added to temporary plans. These ancillary options can also be issued as stand-alone coverage.
After choosing to skip most state Exchanges three years ago, UHC made a robust effort to participate in many more states, and prices were typically very attractive. Copay plans were among the most popular, and were available in the Bronze, Silver, Gold and Platinum tiers. HSA and High-Deductible policies offered quality low-cost coverage, while the over-65 market was well-served with many Medigap contract options. However, beginning four years ago, UHC began to drastically reduce the number of states that it offered personal plans. After rejoining many state Marketplaces in 2022 and 2023, several additional states have been added again. Meanwhile, non-Obamacare plans continue to dominate their portfolio.
Popular Marketplace plans include UHC Bronze Essential, UHC Bronze Standard $9,100 Deductible, UHC Bronze Virtual First, UHC Bronze Value HSA $6,700 Deductible, UHC Bronze Standard $7,500 Deductible, and UHC Silver Advantage.
Seniors across the US use UHC for Medicare Advantage, Medicare Supplement, Prescription Drug (Part D) and Special Needs coverage. The most common Medigap (Supplement) options are Plans A, B, C, F, G, G (HD), and N. Advantage plans, which allow the carrier to offer standard benefits, are popular in many areas because of their low cost. They compete very favorably with other companies. Their out-of-state provider network is very popular for consumers that live in border areas. AARP MedicareRX plans are offered to many persons age 65 and older. The relationship and AARP endorsement remains strong and provides additional exposure in the Senior market.
UHC has been expanding its "virtual visits" benefits, which provide 24/7 coverage for minor issues. Assistance with treating colds and viruses, allergies, migraines, and minor pain can be provided quickly and easily. Tablets, computers, and mobile devices allow face-to-face conversations with physicians. Prescriptions can also be recommended and prescribed. Often, these types of visits can effectively replace trips to a physician's office or Urgent Care facility.
The four Medicare Advantage options at UHC are HMO (most non-emergency services from a local network), PPO (outside of network services also provided), POS (limited outside of network services provided) and PFFS (approved Medicare physicians may be utilized if they agree to UHC's reimbursement options). Current offered plans are: Dual Complete LP, Dual Complete Choice, Dual Complete Select, Nursing Home Plan 1, Nursing Home Plan 2, Assisted Living Plan, Chronic Complete Assure, Medicare Advantage Ally, Medicare Advantage Choice, Medicare Gold, and Medicare Silver.
Aetna
Aetna's Impressive Home Office Is Located In Hartford, CT.
Aetna, like UnitedHealthcare, is one of the nation's biggest carriers and also participated in several State and Federal Marketplaces four years ago. Three years ago, CVS completed the acquisition of Aetna. The $70 billion merger was one of the largest in corporate history. The number of available CVS MinuteClinics has substantially increased, providing fast and easy service to millions of Americans. The network includes more than one million healthcare professionals, and 5,000 hospitals.
A proposed merger with Humana was earlier halted as the Justice Department filed antitrust lawsuits, and both carriers mutually agreed to cease negotiations. Also, several physician groups (American Medical Association is one of the largest) opposed the Aetna-Humana merger, along with the Cigna-Anthem merger. Access, cost, and quality of healthcare were their major concerns.
Although their subsidiary Coventry is also very active in many states, the brand name "Aetna" is one of the most recognizable names in the industry, with its home office in Hartford. In addition to medical coverage, dental, vision, small business and Medicare benefits are available. Senior Medicare Supplement and Advantage products have been given much more attention in recent years. In most states, a wide variety of plans are offered, and prices are very competitive.
Medicare Advantage plans include Aetna Medicare Assure 1, Aetna Medicare Advantra Cares, Aetna Medicare Advantra Credit Value, Aetna Medicare Advantra Eagle, Aetna Medicare Eagle II, Aetna Medicare Advantra Premier, Aetna Medicare Premier 1, Aetna Medicare Premier 2, Aetna Medicare Advantra Premier Plus, Aetna Medicare Advantra Silver, Aetna Medicare Advantra Silver Plus, Aetna Medicare Gold Plan, Aetna Medicare Silver, Aetna Medicare Value, Aetna Medicare Elite, Aetna Medicare Assure 1, Aetna Medicare Premier Plus 1, Aetna Medicare Premier Plus 2, Aetna Medicare Dual Complete, Aetna Medicare Freedom, and Aetna Medicare Choice II.
Part D coverage is offered by SilverScript, and three PDP plans are offered. SilverScript SmartSaver is the least expensive option with preferred generic, generic, and preferred brand drug copays of $2, $15, and 25%. SilverScript Choice offers preferred generic, generic, and preferred brand drug copays of $2, $7, and 17%. SilverScript Plus is the most expensive option and features a $0 deductible with preferred generic, generic, and preferred brand drug copays of $0, $0, and $47.
Marketplace plans are no longer available, although "off-Exchange" contracts may be purchased, along with employer-sponsored, and Medigap options. Although prices are not different (occasionally, a slight difference), a broader network may be available when enrolling "off-Marketplace." Coventry was the brand name associated with Exchange plans in many states, including Pennsylvania and Ohio. Attractively-priced HSA plans were offered, but under-65 products are generally available only through employers as group offerings.
"Traditional Choice" Indemnity plans do not require selecting a primary-care physician, a referral, or finding network providers. Customers can receive treatment from any doctor, and submit the claim form. Preventative programs are offered, and discounted pricing may apply to hospitals and medical facilities. Allstate offers low-cost temporary plans in many states, and utilizes the Aetna PPO network. In selected states, up to 12-24 months of guaranteed coverage is offered. Generally, online telemed office visits and Urgent Care visits are covered without having to meet a deductible
Previously, before the passage of "The Affordable Care Act," Aetna offered popular PPO and HMO plans in most states. Premiums were typically very attractive in many parts of the East and Midwest. In many areas of the country, Aetna's HMO contracts were the most competitive contract available. HSA contracts were very popular in Ohio, Pennsylvania, and several other states.
Currently, Marketplace plans are offered in the following 12 states: Arizona, California, Delaware, Florida, Georgia, Illinois, Missouri, New Jersey, North Carolina, Nevada, Texas, and Virginia. In future years, it's possible that additional states of Marketplace participation will be added, including potential profitable areas in the Midwest, especially Ohio and Indiana.
Cigna
Cigna is a Fortune 500 global services company with more than $30 billion of annual revenues and 70,000 employees. With more than 180 million customers in 30 countries, they are an international service company with a diverse portfolio of products. Individual medical, group life, accident, and disability, dental, pharmacy, health coaching, and vision coverage are offered throughout the world. Here in the US, their single and family (under or over age 65) health insurance plans are available in most states. Both subsidized and unsubsidized contracts are offered. Cigna was previously created when INA and Connecticut General merged in 1982.
Customer support is a strength and a priority at Cigna. A national support line for veterans is available 24/7. 22 service center facilities are located throughout the US for medical and dental customers. More than 40,000 free health screenings are also provided in many cities throughout the country. More than 60,000 pharmacies are included in the provider network, along with an additional 175,000 behavioral and mental health providers.
For Seniors, many Medigap and Medicare-related products and services are available. Cigna-HealthSpring offers Medicare Advantage plans (17 states) while HealthSpring RX offers stand alone prescription drug options (all 50 states) for existing policyholders. Three available Part D plans are listed below. Life and group disability coverage is also offered.
Supplement contracts are also offered. Premiums are very competitive, and policies are guaranteed renewable. Whole Life coverage can also be added to cover funeral expenses, grandchildren's education, and spouse or children's needs. Rates are somewhat attractive, although choosing a major life carrier, such as MetLife, Prudential, Northwestern, or New York Life, will probably provide better choices.
For persons under age 65, Marketplace plans are offered in the following states: Arizona, Colorado, Florida, Georgia, Illinois, Kansas, Mississippi, Missouri, North Carolina, Pennsylvania, Tennessee, Utah, and Virginia. The HSA Bronze and HSA Silver plans are very popular for healthier households seeking low rates and an additional tax deduction.
Flex Silver and Flex Gold plans provide lower deductibles and copays. Virtual care office visits are provided with a $0 copay. Expatriate International policies are also offered in 12 countries through "Global Health Benefits." Benefits are offered from $1 million to "unlimited."
Several popular ACA Marketplace plans are listed below:
Cigna Connect 8700 -- 0% coinsurance
Cigna Connect Flex Bronze 8700 -- 0% coinsurance
Cigna Connect 8500 -- $60 copay for pcp office visits and $90 copay for specialist visits (deductible waived). $15 preferred generic drug copay.
Cigna Connect 8000 -- $50 copay for pcp office visits and $110 copay for specialist visits (deductible waived). $3 preferred generic drug copay.
Cigna Connect Flex Bronze 7200 -- $40 copay for pcp office visits (deductible waived).
Cigna Connect HSA 7000 -- 0% coinsurance and HSA-eligible.
Cigna Connect HSA Bronze 6500 -- 0% coinsurance and HSA-eligible.
Cigna Connect Flex Bronze 5400 -- $30 copay for pcp office visits (deductible waived). $3 preferred generic drug copay.
Cigna Connect Flex Gold 900 Copay -- $10 copay for pcp office visits and $60 copay for specialist visits (deductible waived). $3 preferred generic drug copay and $10 generic drug copay.
Like most carriers, group policies are offered through small and large employers, along with various ancillary products, such as dental, vision and disability. Online tools and resources are easily accessible for the policyholder, or for brokers and/or websites like ours to assist customers. Most importantly, there are several low-cost plans available in most areas including pharmacy management and voluntary products.
Senior Part D prescription drug plans offered include Cigna Secure Rx ($445 deductible with Tier 1, 2, and 3 drug copays of $1, $2, and $30), Cigna Secure-Extra Rx ($100 deductible with Tier 1, 2, and 3 drug copays of $4, $10, and $42) and Cigna Secure-Essential Rx ($445 deductible with Tier 1, 2, and 3 drug copays of $0, $2, and 18%).
Kaiser Permanente
Kaiser Westside Medical Center In Oregon Opened In 2013
Kaiser is actually two separate large organizations. Kaiser Foundation Health Plan And Hospitals is a non-profit entity and works with Permanente Medical Groups. Although coverage is only offered in the District Of Columbia and eight additional states, about 12 million persons receive services and/or benefits. Currently, they are based in Oakland and are very active in the California Marketplace. Other states they currently write business include Georgia, Oregon, Colorado, Hawaii, Maryland, Virginia, and Washington, and the District of Columbia.
Created and founded in 1945, their stated goal is to keep their customers and clients healthy. And with a large emphasis on preventive benefits and management, their policyholders are among the healthiest in the US, when compared to other insurers. Dozens of Kaiser medical centers are located throughout the US, including Los Angeles, San Diego, and Richmond. Currently, Kaiser is not rated by A.M. Best Company Health Insurance Ratings. However, they are rated by several other companies. Customer satisfaction is generally very high, and most policyholders renew their plans after the first year.
Typically, Kaiser is ranked highly for quality and preventative care. The National Committee For Quality Assurance (NCQA) recently awarded their highest ratings for breast cancer and cervical cancer screening, adult BMI assessment, control of high blood pressure, Beta-Blocker treatment after a heart attack occurs, patient-monitoring when receiving regular medications, and nutrition for children. Other awards received have been for safety procedures and patient safety, supplier diversity, hypertension control, nursing anesthesia, adult heart surgery, clinical excellence, best hospital for obstetrics, military friendly, Medicare plan ratings, and for improvements in community health.
Kaiser Senior Advantage (HMO) plans are very popular (where available) for applicants that are Medicare-eligible. Monthly premiums in California are often $0 and primary-care physician and specialist office visit copays are as low as $5. Urgent-Care visits also may be subject to a low $5 copay. Washington, and Virginia, for example, have higher rates, copays, and maximum out-of-pocket expenses. The policy received a 5-Star rating from Medicare, its highest possible score. Policies are re-rated each year and can always change.
Popular Kaiser Medicare Advantage plans include Senior Advantage LA Orange Co., Senior Advantage Inland Empire, Senior Advantage San Diego, Sr Adv Enhanced Santa Clara, Sr Adv Basic Santa Clara, Senior Advantage Basic Stanis, Senior Advantage Advanced Stanis, Senior Advantage Marin San Mateo, Senior Advantage Basic SnJoaq, and Senior Advantage Enhanced SnJoaq.
Small business plans are offered in Georgia, California, Hawaii, Colorado, Oregon, Washington, Virginia, Maryland, and Washington D.C. Traditional and deductible HMO plans, POS plans, PPO plans, HSA-Qualified Deductible, and HRA plans are offered.
Humana
Humana is one of the most widely-admired healthcare companies in the United States. Based in Louisville, they offer very competitively-priced medical plans to large and small businesses. They no longer offer under-65 single or family Marketplace plans. Originally created as a nursing home company, Humana has evolved over the years as leader in individual and family coverage for persons under age 65 and Seniors. Their Senior portfolio is as extensive as any other major carrier, with products offered in most states.
Three prescription drug plans (Part D) are offered (Basic Rx, Premier Rx, and Walmart Value Rx), while wellness and fitness programs are often included in Medigap contracts. Medicare Advantage plans offered include Gold Choice PFFS, Gold Plus Diabetes And Heart C-SNP, Gold Plus HMO, Gold Plus SNP-DE, and Honor PPO.
Private individual policies were previously available in 22 states including most Midwestern, Central plains and Western areas. However, in California and most of the Northwest (Washington, Oregon, Idaho, Montana and Wyoming), policies were not offered. Depending upon future legislation, it's possible that private medical plans may be offered in the future. The earliest possible Exchange return is 2023.
As the third-largest health insurance company, they offer extensive support to the US Department of Defense and TriCare. Also, their coverage of active-duty and retired military personnel is very extensive, with more than 3 million persons covered. "Humana Military" helps VHA and additional federal agencies in the operation and delivery of quality medical coverage. Wisconsin Physicians Service (WPS) is a claims partner that helps administer Parts A and B Medicare coverage for Seniors.
Two popular ancillary products that are frequently needed by individuals and families on a stand-alone basis are dental and vision. Humana offers one of the most consumer-friendly ways to apply online and easily enroll and obtain coverage. Typically, the process takes less than 15 minutes, and applicants are not required to be enrolled in other products to qualify. A broad network of providers are offered, and economical and more expensive comprehensive benefits are available.
Many consumers choose their dental and vision products, while retaining group medical coverage through an employer. Dental plans available are: Dental Loyalty Plus, Dental Value, Dental Preventive Plus, Dental Savings Plus, and Complete Dental. Vision plans include an annual vision exam and an annual allowance that can be used for lenses or contacts. Frame allowances are provided every 12-24 months.
Go365 is available, and provides a health assessment, along with a customized wellness and rewards program. Rewards are given to participants, that complete specific tasks, such as verified workouts, flu shots, immunizations, routine annual physical, eye and vision check-ups, and wellness screenings. Earned points (dollars) can be used for movie tickets, gift cards, charitable contributions, and several other options. A drug pricing guide is available to all customers.
HCSC (Health Care Service Corporation)
HCSC is perhaps the largest company in the US that nobody heard of! Health Care Service Corporation is owned by its customers and consists of several health insurance carriers and their subsidiary companies. The largest entities include Blue Cross and Blue Shield of Texas, Montana, Illinois, New Mexico and Oklahoma. And with more than 20,000 employees and about 15 million policyholders, this carrier is a "big player" in the industry. With policyholders owning the carrier instead of investors, patients become the sole priority with the absence of shareholders.
The state with the most policyholders is Illinois, followed by Texas, Oklahoma, New Mexico, and Montana. The most affordable plans offered in Illinois are Blue Precision Bronze HMO 205, Blue Choice Preferred Bronze PPO 201, Blue Choice Preferred Bronze PPO 202, BlueCare Direct Silver 212 With Advocate, and Blue Precision Silver HMO 206.
Originally created in 1936, HCSC offers more than medical insurance coverage. Dearborn National, a fully-owned subsidiary, offers dental, disability and life plans. Both stand-alone and attachment contracts are available. Other subsidiaries include Availity (Internet healthcare information), Dental Network of America (third-party administrator), Prime Therapeutics (Pharmacy benefit management), Medecision (Case and disease management), TMG (Business Process Outsourcing), Dearborn National (Group life, disability, and dental), HCSC Services (administers Medicare and Medicaid), and Triwest (Military family coverage).
Many innovative tools and programs are offered to customers to help maintain and manage health. Blue Care Advisors provide condition and care management, for persons that are currently in the hospital, or being treated for serious or chronic conditions. A Wellness initiative provides a 24/7 nurse hotline, a fitness program, lifestyle management assistance, and a "Special Beginnings" maternity program. Additional online tools allow customers to review claims statuses, locate physicians or hospitals, and receive directions, obtain duplicate identification cards, and utilize available tools to determine (in advance) cost of treatment.
Safety is not a concern since they have earned an "A" rating from the three major rating agencies (A.M. Best Co., Standard & Poors, and Moody's Investor Service). As a customer-owned carrier, there is no stock available for purchase, and thus, there are no shareholders. The first policy was written in 1937, and HCSC continues to be an independent licensee for Blue Cross and Blue Shield Association. Headquartered in Chicago, HCSC, like many other carriers, are increasing their focus on Senior products, as Marketplace participation continues to decline.
Highmark BCBS and UPMC Dominate Western Pa Healthcare
Highmark
Based in Pittsburgh, Highmark provides benefits to more than 5 million persons countrywide. Their main products are health insurance, dental, and vision coverage, and its reinsurance operations. Most of the individual and group healthcare plans are provided in Pennsylvania, West Virginia, and Delaware. Previously, they merged with Northeastern Blue Cross of Pennsylvania (BCNEPA) and operate under "Highmark Blue Cross Blue Shield, which provides plan in 42 Pa counties. BCBS Delaware services the entire state of Delaware, and BCBS West Virginia services the entire state of West Virginia and one Ohio county (Washington).
Operating under the Blue Cross and Blue Shield name, they are one of the nation's largest BCBS carriers. Their rates are typically very competitive, especially in the home territory of Western Pennsylvania, where battles with current nemesis UPMC frequently take place in policy pricing, network availability, and the courts. In Allegheny and Westmoreland Counties, rates are extremely competitive for both individual and group products. Generally, the only other carriers in the area that provide strong competition (other than UPMC) are Aetna and UnitedHealthcare. Affiliate United Concordia provides dental coverage while affiliates Visionworks Of America and Davis Vision underwrite vision plans.
One of the major contributions of Highmark was the establishment of their juvenile health insurance program designed for children. Many years later, the national CHIP program was created, based on the existing program that was created in Western Pennsylvania. Still today, the CHIP program has assisted hundreds of thousands of children obtain affordable medical coverage.
For Seniors, popular Medicare Supplement policy options are Plans F (High-Deductible), A, N, B, C, and F. Available Medicare Advantage contracts include Community Blue HMO Signature, Security Blue HMO Basic, Security Blue HMO ValueRx, Freedom Blue PPO Select, Community Blue Medicare HMO Prestige, Security Blue HMO Standard, Security HMO Deluxe, and Freedom Blue PPO Classic. Prescription drug plans (Part D) that are available, include Blue Rx PDP Plus and Blue Rx PDP Complete.
"Highmark Direct" stores are available for consumers in 11 locations. Exchange, Senior Medicare, and ancillary products can be discussed. Offices are located in Lancaster, Allentown, North Hills, Harrisburg, Mechanicsburg, South Hills, Easton, Monroeville, Williamsport, Erie, and North Fayette.
Blue Shield Of California
Blue Shield is a non-profit carrier offering coverage to California residents. Based in San Francisco, they were founded in 1939 and currently have more than 4 million members covered. Revenue is more than $10 billion each year, and they receive "A" ratings from A.M. Best Company, Weiss, and Fitch. Their "Blue Ribbon" program recognizes physicians for their outstanding service in the state. They also were the first healthcare carrier to include benefits for heart transplants and general catastrophic coverage.
With more than 6,000 employees, they are NCQA- accredited (National Committee For Quality Assurance) and have more than 60,000 pharmacies in their Network. Life and disability products are offered through the life-insurance subsidiary, which is Blue Shield of California Life and Health Insurance Company. Extensive dental and vision products are also available at very competitive prices. Traveling outside of the US? No problem, since BlueCard coverage can be used in more than 200 countries.
As a non-profit entity, annual net income is capped at 2% of revenue. Any excess profits are given back to policyholders or the general community. So far, about $500 million has been given back. Holistic treatment is offered on many plans with emphasis on preventive benefits (always covered at 100%) and professional and personal case management with online access to nurses and other providers at any time. For Seniors, a full range of products is offered, including Medicare Supplement plans, Advantage plans, and prescription drug plans.
Popular private plans for persons under age 65 include Minimum Coverage PPO ($7,900 deductible), Bronze 60 HDHP PPO ($6,000 deductible), Bronze 60 PPO ($6,300 deductible), Silver 1850 PPO ($1,850 deductible), and Gold 80 Trio HMO ($0 deductible). These plans are available through the Covered California Marketplace and are eligible for federal subsidies.
Medicare Supplement contract options offered are Plans A, C, D, F, F (HD), K, and N. Blue Shield Life underwrites each policy. Two Medicare prescription drug (Part D) options are available. The Blue Shield Medicare Basic plan has a lower premium and a $400 deductible (not applicable to Tier 1 drugs). The Blue Shield Medicare Enhanced plan has no deductible.
Independence Blue Cross
Independence Blue Cross (IBX or IBC) is Southeastern Pennsylvania's biggest provider of medical coverage for individuals and businesses. However, they aren't limited to covering persons in the Pa area (currently more than two million) since they insure more than eight million persons in 25 states. More than two million persons are covered in just the Philadelphia area (Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties). Currently, they are one of two carriers (Ambetter is the other company) that offers Exchange options in Southeastern Pennsylvania, since Aetna has exited that market.
As an Independent licensee of the Blue Cross and Blue Shield Association, IBC offers Marketplace plans, off-Exchange contracts, and group coverage for small and large employers. CHIP and "Special Care" plans are also offered. In the Philadelphia area, along with Aetna, they are a very popular individual and group choice, and maintain a significant market share. Their network provider list extends to New Jersey, which makes IBX one of the best options in Philadelphia. Affiliated companies include AmeriHealth, AmeriHealth Casualty Services, AmeriHealth Caritas, NaviNet, and Tandigm Health.
Policy options for consumers under age 65 are Personal Choice Bronze Classic, Personal Choice PPO Bronze Reserve, Personal Choice PPO Bronze, Keystone HMO Silver Proactive, Keystone HMO Silver, Personal Choice PPO Silver, Keystone HMO Gold Proactive, Keystone HMO Gold, Personal Choice PPO Gold, Keystone HMO Platinum, and Personal Choice PPO Platinum. A "catastrophic" plan is not offered. Silver-tier plans are popular options for low-income households, since "cost-sharing" can substantially reduce deductibles, copays, and maximum out-of-pocket expenses.
Seniors can also obtain affordable coverage as Supplement (MedigapSecurity) contracts are available. Referrals and choosing a primary-care physician are not necessary. Plans A, B, C, F, and N are offered. Popular Medicare Advantage HMO plan options are the Keystone 65 Focus, Select, and Preferred. A Personal Choice PPO plan is also offered. All plans include SilverSneakers fitness benefits.
Centene Corporation
Centene is a diversified Fortune 500 Company that provides medical coverage in 31 states through private individual plans, Medicaid, CHIP, Foster Care, and Special Needs Plans through Medicare. Temporary Assistance For Needy Families (TANF) and coverage for the aged, blind, and disabled (ABD) are additional Medicaid programs that are utilized. In 10 states, benefits are provided through Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs).
They also contractually provide many additional services, including dental benefit and pharmacy benefits management, health and life management, correctional service, and home aid assistance. Health Net provides health insurance to 11 million persons, and merged with Centene to create the biggest Medicare managed care company in the US. Plans are offered to about 6 million persons in all states. HMO, PPO, and POS products are available.
For persons under age 65, single and multi-person Marketplace plans are offered, with, and without a federal subsidy. Coverage is available in the following 18 states: Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Missouri, New Hampshire, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Washington. Ambetter underwrites plans, and generally, rates are extremely competitive. Popular policies include Balanced Care 1, Balanced Care 2, Balanced Care 5, Balanced Care 10, Balanced Care 11, Essential Care 2, and Secure Care 1.
Several of the most prominent Centene companies are Cenpatico (Arizona), Sunshine Health (Florida), Peach State Health Plan (Georgia), Illinicare Health (Illinois), Sunflower Health Plan (Kansas), Centurion (Minnesota, Tennessee, Vermont, and New Mexico), Magnolia Health (Mississippi), Buckeye Health Plan (Ohio), Trillium (Oregon), Absolute Total Care (South Carolina), Superior HMO (Texas), Coordinated Care (Washington), and MHS Health Wisconsin (Wisconsin).
Centene's "Whole Health Solutions" provide many services to customers, including comprehensive specialty drug management, vision services with exams and frame benefits, pharmacy services, dental care benefits, and 24/7 nurse line services. The "Envolve" family of companies provides the following services: vision, dental, nurse advice line, management of diabetes, pharmacy management, and management service organization services.
Centurion provides staffing services to correctional institutions and government agencies. Coverage is offered in 13 states. As a World Economic Forum Strategic Partner, facilities, specialty services, advanced technology, and personalized care are provided in Spain, Latin America, and the United Kingdom.