United States Health and Medical Insurance Market

The market is segmented by Procurement Type (directly purchased, employer sponsored), Products and Services (PBMs, HDHPs, FFS/Traditional indemnity Plans, and Managed Care Plans (HMO, PPO, POS, Other Products and Services), Place of Purchase (On Exchange and Off Exchange) - Growth, Trends, and Forecast (2019-2024)

Market Snapshot

US market snapshot
Study Period:

2015-2024

Base Year:

2018

CAGR:

The US health and medical insurance market is expected to register a healthy CAGR of 8.1%, during the forecast period of 2019-2024.

Key Players:

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Market Overview

The US healthcare insurance market is the largest in the world, without adhering to WHO's Universal Health Coverage. The United States continues to top the growth in health premiums in North America, with an absolute growth of about GBP 40 billion and at an annual rate of 6%, from 2015-2016. This growth can be attributed to medical inflation, increasing employment, and some carry-over of the benefits from the former US President Obama’s healthcare policies. According to cdc.gov - Centre for Disease Control and Prevention, the average per person expenditure on health in the United States was ~USD 9500. The US government has laid down numerous health care legislations, to provide health cover to a majority of US population.

According to the NAIC (National Association of Insurance Commissioners), more than 60% of health care coverage was provided by private insurance programs, such as PPOs, HMOs, POS plans, etc. The leading 125 insurers in the United States accounted for about USD 713 billion, of which more than 60% came from top 25 health insurers. About 6% of Americans purchase health insurance in the individual and small group market, and 50% of them buy policies on the exchanges. Around 85% of exchange purchasers receive a premium subsidy (ASPE 2017).

Drivers:

  • Increase in the total health expenditure, which includes both public and private spending on the programs that promote health and prevent disease, with the utilization of medical, paramedical, and nursing knowledge and technology
  • Growth in the overall employment increases the demand for health insurance through both individual and employer-sponsored health coverage

Restraints:

  • Government regulations and related policy orders effecting a lot of unprecedented changes in the way healthcare coverage is being offered to the American citizens

Scope of the Report

A complete background analysis of the US Health Insurance industry, including an assessment of the national health accounts, economy, and emerging market trends by segments, significant changes in market dynamics, and market overview, is covered in the report.

By procurement type
Directly/Individually Purchased
Employer-based
Small Group Market - Organizations with 2 to 50 Employees
Large Group Market - Organizations with More than 50 Employees
By Products and Services Offered
Pharmacy Benefit Management (PBM)
High Deductible Health Plans (HDHPS)
Fee-for-service (FFS) Plans (non-PPO) or Traditional Indemnity
Managed Care Plans - Preferred Provider Organization Plans (PPO), Health Maintenance Organization Plans (HMO), Point-of-service (POS) Plans, and Other Managed Care Plans
By Place of Purchase
On Exchange/Marketplace
Off Exchange/Marketplace

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Key Market Trends

High Deduction Health Plans Gaining Popularity among Public

These are plans with a higher deductible than any traditional insurance plan. The monthly premium is usually lower, but one pays more health care costs themselves before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing one to pay for certain medical expenses with money free from federal taxes. The IRS defines a high deductible health plan as any plan with a deductible of at least USD 1,350 for an individual, or USD 2,700 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) cannot be more than USD 6,650 for an individual, or USD 13,300 for a family (does not apply to out-of-network services).

The enrollment number for these plans continues to grow YoY, as many employees feel the need to combat the rising healthcare prices. Rising consumerization may continue to drive the tremendous growth of voluntary benefits among employees, and therefore, the HDHPs are gaining popularity, in order to manage costs. The large group market with more than 50 employees remains the most popular setting for HDHP and HAS enrollment, according to AHIP. In 2017, 82% of enrollment occurred in large employer settings, followed by the small-employer market (11%) and the individual market (7%).

Market plans segm

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Insights on Private Health Insurance (PHI) in the United States

About 60% of the US population utilizes private health insurance services to take care of their health needs. PHI usually covers those that are uncovered, or covered partially, under any public health program. In 2014, to promote individual responsibility, the Obamacare had taken an initiative to impose fine on those who do not possess adequate health insurance coverage.  Private health insurance can be obtained through a state run program, which automatically enrolls its residents or through employer supported programs, or must be bought individually to meet their future healthcare needs.

According to US Census Bureau, in 2017, private health insurance coverage stood at 67.2%, significantly higher than the government coverage (37.7%). Within the various segments of health insurance coverage, employer-based insurance was the most common, which covered about 56% of the population for few months, or all year, followed by Medicaid (19.3%), Medicare (17.2%), direct-purchase coverage (16.0%), and military coverage (4.8%). Private health insurance spending growth is projected to have increased by 0.5%, to 5.6%, in 2017, partly due to the increase in health insurance marketplace premiums. However, the spending is expected to slow by 0.7%, on an average, for 2019-2020.

Market segmentation

Competitive Landscape

According to a report from the American Medical Association (or AMA), the private health insurance industry is highly concentrated, with 72% of total metropolitan areas lacking significant health insurer competition.

The Henry J. Kaiser Family Foundation measured the competitiveness of the private health insurance market in 2013, using the Herfindahl-Hirschman Index (HHI) as an indicator. The HHI takes into account how much of a market is controlled by each of the companies competing within it (market share), and is expressed in a value between zero and 10,000. The lower the number, the more competitive the market. Higher concentration from the M&A of various health insurers is expected to raise antitrust concerns among consumers. This is a result of the monopoly power of the health insurer, due to the consolidation, which gives them a leverage to raise and maintain the premiums above the competition levels.

Most of the M&A activities are focused on insurance companies tying up with PBMs, to manage the rising healthcare costs. Few examples include CVS merger with Aetna (USD 69 billion). This merger combines CVS' pharmacies with Aetna's insurance business, in hopes of lowering costs.  Cigna and Express Scripts closed on a USD 67 billion merger, to lower healthcare costs and deliver better outcomes. Walmart and Humana, which had earlier partnered on a low-cost Medicare Part D prescription drug plan, have an impressive array of medical – PBM – retail capabilities focused on serving the growing medicare advantage market.

Major Players

  1. UnitedHealth Group
  2. Anthem
  3. Humana Group
  4. HCSC Group
  5. Centene Corporation

* Complete list of players covered available in the table of contents below

US CL

Table of Contents

  1. 1. INTRODUCTION

    1. 1.1 Scope of the Study

    2. 1.2 Key Deliverables of the Study

    3. 1.3 Study Assumptions

  2. 2. RESEARCH METHODOLOGY

    1. 2.1 Analysis Methodology

    2. 2.2 Research Phases

  3. 3. EXECUTIVE SUMMARY

  4. 4. GOVERNMENT REGULATIONS AND INITIATIVES

    1. 4.1 Brief on Patient Protection and Affordable Care Act (ACA, Obamacare) and its implications on the Overall Health Insurance Coverage

    2. 4.2 Insights on Latest Healthcare Policy Changes and their Effect on the Health Spending by US Citizens

  5. 5. INDUSTRY DYNAMICS AND INSIGHTS

    1. 5.1 Brief on Health Insurance Premiums and Study on the Effect of Medical Trend Rate on Health Plans

    2. 5.2 Insights on the Growing Online Sales of Health Insurance and the Growth Prospects in Health Insurance Sector

    3. 5.3 Technological Advancement and Innovation in Health Insurance Sector

    4. 5.4 Industry Attractiveness - Porter's Five Forces Analysis

    5. 5.5 Value Chain/ Supply Chain Analysis

  6. 6. MARKET SEGMENTATION

    1. 6.1 By procurement type

      1. 6.1.1 Directly/Individually Purchased

      2. 6.1.2 Employer-based

        1. 6.1.2.1 Small Group Market - Organizations with 2 to 50 Employees

        2. 6.1.2.2 Large Group Market - Organizations with More than 50 Employees

    2. 6.2 By Products and Services Offered

      1. 6.2.1 Pharmacy Benefit Management (PBM)

      2. 6.2.2 High Deductible Health Plans (HDHPS)

      3. 6.2.3 Fee-for-service (FFS) Plans (non-PPO) or Traditional Indemnity

      4. 6.2.4 Managed Care Plans - Preferred Provider Organization Plans (PPO), Health Maintenance Organization Plans (HMO), Point-of-service (POS) Plans, and Other Managed Care Plans

    3. 6.3 By Place of Purchase

      1. 6.3.1 On Exchange/Marketplace

      2. 6.3.2 Off Exchange/Marketplace

  7. 7. COMPETITIVE LANDSCAPE

    1. 7.1 Overview (Market Concentration and Major Players)

    2. 7.2 Company Profiles

      1. 7.2.1 UnitedHealth Group

      2. 7.2.2 Anthem

      3. 7.2.3 Humana Group

      4. 7.2.4 HealthCare Services Group Inc.

      5. 7.2.5 Centene Corporation

      6. 7.2.6 Aetna Inc.

      7. 7.2.7 Kaiser Foundation Group

      8. 7.2.8 Independence Health Group Inc.

      9. 7.2.9 Molina Healthcare

      10. 7.2.10 Guide Well Mutual Holding Corp.

    3. *List Not Exhaustive
  8. 8. FUTURE GROWTH PROSPECTS OF THE US HEALTH INSURANCE INDUSTRY

  9. 9. APPENDIX

    1. 9.1 United States Public Health Insurance Statistics - Medicare Part A, Medicaid, TRICARE, Veterans Health Coverage, CHIP coverage

    2. 9.2 Trend Analysis of Per Capita Health Expenditure in United States

    3. 9.3 Statistics on Age-wise Health Insurance Coverage

  10. 10. DISCLAIMER AND ABOUT US

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