Offering or enrolling in health insurance is a significant decision for employers and individuals. It can be overwhelming to know where to start, especially if you’re a small business without an HR team or a benefits specialist to help. But, putting in the time and research to set up a formal health benefit plan is well worth the effort. There are several advantages to offering an employer-sponsored health insurance plan, including helping to retain and attract employees, making your business stand out, and contributing toward a happy and healthy workforce. In this article, we’ll list the top 25 health insurance companies in the United States by market share and provide alternative coverage options if you want to offer something more cost-effective and flexible than traditional group health plans.

Advantages of Employer-Sponsored Health Insurance

Employer-sponsored health insurance offers several advantages. It helps retain and attract employees, making your business stand out. Moreover, it contributes to a happy and healthy workforce, which can boost overall productivity and morale.

Overview of Health Insurance Options

When considering health insurance, there are traditional group health insurance plans and more flexible alternatives like Health Reimbursement Arrangements (HRAs) and health stipends. Understanding these options can help you choose the best plan for your needs.

What is Traditional Group Health Insurance?

Traditional group health insurance involves employers choosing a group medical plan for their organization. They offer coverage to employees and eligible dependents at a reduced rate. Typically, insurers require a 70% minimum participation rate to provide coverage. There are various plan types, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

Cost Considerations for Group Health Insurance

The cost of group health insurance can vary, but rates generally increase annually. In 2023, the average annual premium for group health insurance was $8,435 for self-only coverage and $23,968 for family coverage. Employers contributed $7,034 to employees’ self-only plans and $17,393 to their family plans. Despite their popularity, the high costs can be prohibitive for smaller businesses.

Top 25 Health Insurance Companies in the U.S.

Understanding which health insurance companies are credible and provide a wide range of products is crucial when searching for coverage. Here are the top 25 health insurance companies in the United States by market share size:

  1. UnitedHealth Group (including UnitedHealthcare) – 15.34%
  2. Elevance Health Inc. (formerly Anthem) – 7.16%
  3. Centene Corp. – 6.68%
  4. Kaiser Foundation (Kaiser Permanente) – 6.18%
  5. Humana – 6.03%
  6. CVS Health (including Aetna Health) – 5.82%
  7. Health Care Services Corporation (HCSC) – 3.53%
  8. Cigna Health – 2.39%
  9. Molina Healthcare Inc. – 1.99%
  10. GuideWell (including Florida Blue) – 1.84%
  11. Independence Health Group Inc. – 1.76%
  12. California Physician’s Service – 1.40%
  13. Highmark Group – 1.32%
  14. Blue Cross of California – 1.15%
  15. Blue Cross Blue Shield of Michigan – 1.11%
  16. Blue Cross Blue Shield of New Jersey – 1.11%
  17. Caresource – 0.93%
  18. UPMC Health System – 0.90%
  19. Blue Cross Blue Shield of North Carolina – 0.79%
  20. Carefirst Inc. – 0.70%
  21. Metropolitan – 0.69%
  22. Point32Health Inc. – 0.63%
  23. Health Net of California, Inc. – 0.63%
  24. Local Initiative Health Authority – 0.61%
  25. Blue Cross Blue Shield of Massachusetts – 0.60%

Understanding Premium Revenues

According to the 2022 NAIC Health Insurance Report, U.S. health insurers earned approximately $1 trillion in total net earned premiums, marking an 11.4% increase from 2021. UnitedHealth, leading the list, wrote roughly $221 billion in premiums in 2022, while Blue Cross Blue Shield of Massachusetts wrote $8.6 billion.

Market Trends and Predictions

Experts predict that rising medical service needs due to inflation, worsening health conditions, and older, higher-risk patients will increase premium costs. Therefore, offering a range of health insurance options and additional benefits like wellness programs can better attract and retain employees.

Alternative Health Benefits for Small Employers

For small and midsize businesses, budgeting for group medical insurance can be challenging. However, alternative options like Health Reimbursement Arrangements (HRAs) and health stipends offer flexible and cost-effective solutions.

Qualified Small Employer HRA (QSEHRA)

QSEHRA is a health benefit for employers with fewer than 50 full-time equivalent employees. Employers set an allowance up to the annual maximum contribution limit, and employees choose their insurance policy and medical expenses. QSEHRA reimbursements are income-tax-free if the policy provides minimum essential coverage (MEC).

Individual Coverage HRA (ICHRA)

ICHRA is a flexible benefit for employers of all sizes, with no maximum contribution limits. Employers can use it as a standalone benefit or alongside a group health insurance policy. Employees must choose between the group plan or the ICHRA, and only those with a qualified individual health plan can participate.

Integrated HRA (GCHRA)

Integrated HRAs are for employers offering a group health insurance plan who want to supplement benefits. This type of HRA reimburses eligible out-of-pocket costs, such as deductibles and coinsurance, but not premiums. Employers can set unlimited allowance amounts and customize the benefit according to employee classes.

Health Stipends

Health stipends are flexible, flat amounts given to employees for health insurance policies and other medical expenses. They are taxable but offer more choice in spending. However, they don’t satisfy the employer mandate for large employers.

How PeopleKeep Can Help

PeopleKeep’s employee benefit administration software simplifies the process of managing HRAs and stipends. The platform helps employers design benefit plans, automates tasks, and ensures compliance. With expert support, employers can offer affordable and customizable benefits to their employees.


Offering health

insurance involves many options, from traditional group plans to flexible alternatives like HRAs and health stipends. Employers should consider these alternatives to provide affordable and comprehensive health benefits that meet their employees’ needs.


1. What are the main benefits of employer-sponsored health insurance?

Employer-sponsored health insurance helps retain and attract employees, enhances business reputation, and contributes to a healthy and productive workforce.

2. How do HRAs differ from traditional group health insurance?

HRAs offer a flexible, tax-free reimbursement method for medical expenses, while traditional group health insurance involves providing a set group plan to employees at a reduced rate.

3. What is the role of the ACA in health insurance?

The Affordable Care Act (ACA) mandates that applicable large employers provide affordable health insurance options to their employees, ensuring coverage and preventing penalties.

4. How can small businesses afford health insurance?

Small businesses can consider alternatives like HRAs and health stipends, which offer flexible and cost-effective solutions for providing health benefits.

5. What are the tax benefits of offering health insurance?

Employers can benefit from tax credits and deductions for offering health insurance, reducing overall costs while providing valuable benefits to employees.

By Tempail

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