Explore top health insurance companies by state
In the U.S., the five largest health insurers (UnitedHealth Group, Elevance Health, CVS Health’s Aetna, Cigna, and Health Care Service Corporation) together held 57% of the commercial health insurance market in 2024, according to the American Medical Association. However, state-by-state figures reveal that different companies have varying levels of enrollment rates across the country. Some states are primarily serviced by large insurers, while others rely heavily on locally operated carriers. Knowing which company claims the largest share of the market is useful for individual policyholders, employers, and insurance agents seeking employment opportunities in a given state.
The companies presented below shape the competitive landscape of each state’s health insurance market. Keeping up with market and coverage trends is critical for delivering the most relevant and up-to-date advice to clients. The following figures also provide valuable career insights for agents interested in joining a company with a strong presence in their state or region.
Top health insurance companies by enrollment: National view
According to KFF, the three largest insurers in the U.S. large group market (health plans sold to larger employers) by enrollment in 2024 were Kaiser Permanente, UnitedHealth, and Elevance (formerly Anthem). Leading the nation was Kaiser, which enrolled about 6.8 million members in large group plans that year, an 18% share of that market nationwide.
| Insurer name | Enrollment | Market share |
|---|---|---|
| Kaiser Permanente | 6,825,943 | 18% |
| UnitedHealth Group | 4,497,951 | 12% |
| Elevance Health Group | 3,689,983 | 10% |
UnitedHealth secured the second position, with 4.5 million large group members and a 12% share. Elevance Health was third, holding 10% of the market and serving 3.7 million people through its large group plans.
The full data release provides details on the three largest health insurance companies in each state, as well as at the national level. For convenience, we will highlight the companies that claimed the number one spot in each jurisdiction by number of policyholders.
Top health insurance companies by state
The color-coded map below illustrates the concentration of top insurance companies across the U.S., based on the number of people enrolled in each state’s large group market. Enrollment data approximate the number of people covered under comprehensive major medical insurance and mini-med plans offered by these carriers.
BlueCross BlueShield (BCBS) companies led the large group market in more states than anyone else: independent BCBS companies held the top spot in 30 of the 50 states and Washington, D.C., in 2024. The BlueCross name is shared by a federation of independently owned, locally operated organizations, which may account for its extensive reach. Elevance Health, which runs Anthem Blue Cross Blue Shield plans, led in eight states, and Health Care Service Corporation (HCSC), also part of the BCBS system, led in five, so BCBS-licensed companies were the largest insurer in 43 of 51. Kaiser Permanente led in three states.
In some areas, a single company insures most people in the large group market: in Wyoming, Blue Cross Blue Shield of Wyoming held 91% of that market in 2024. Other markets, by contrast, are more varied: in New York, CVS Health (Aetna) led with just 18% of large group enrollees, reflecting a broader distribution of carriers.
In California, over 5 million residents were enrolled in large group plans with Kaiser Permanente, the state’s largest insurer in that market. Kaiser covered 55% of large group enrollees in the country’s most populous state. Notably, more than three-quarters of Kaiser’s large group members nationwide are in California, highlighting how some firms achieve geographic dominance.
Why it matters for agents
Knowing which companies serve the most clients in a given area is key for insurance professionals, as insurance licenses restrict where agents can practice. Captive agents are likely to find more employment opportunities at companies that have established a strong market presence in a particular state. Independent health insurance agents, on the other hand, must establish carrier agreements with major insurers or top regional companies to become authorized sellers. These agreements enable agents to recommend plans, compare options with clients, and transact insurance policies from these providers in their state or areas of operation.
The leading companies and diversity of each market will directly impact opportunities for employment and contracting, especially for captive agents who exclusively represent a single company. Independent agents should be aware of which providers serve the most consumers in their area and familiarize themselves with their policy offerings. Each insurer sets its own contract standards and commission rates, so researching the major carriers in a specific jurisdiction can help lead agents toward favorable career prospects.
If you’re an agent evaluating your options in the health insurance industry, identifying if your state is a leading hub for major insurers and a top place of employment can help inform your next steps in your professional journey.
States with the most insurance sales agents
Agents may be curious to know which areas have a thriving insurance market beyond company profiles. The U.S. states with the highest employment of insurance agents tend to be highly populous and home to major urban and employment centers, which create opportunities for health insurance professionals.
| State | Employment |
|---|---|
| Florida | 47,560 |
| Texas | 47,060 |
| California | 41,160 |
| New York | 22,420 |
| North Carolina | 20,540 |
| Pennsylvania | 19,390 |
| Georgia | 18,030 |
| Illinois | 16,360 |
| Ohio | 16,250 |
| Michigan | 12,160 |
Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (May 2025)
These elevated employment numbers underscore the ongoing demand for licensed agents in these states, although competition among professionals may be more intense. Two of these states, New York and California, are also among the 10 best-paying states for insurance sales agents:
| State | Hourly mean wage |
|---|---|
| District of Columbia | $57.39 |
| Massachusetts | $49.55 |
| New Jersey | $49.26 |
| New York | $48.92 |
| Minnesota | $48.21 |
| Rhode Island | $45.80 |
| Alabama | $45.62 |
| Wisconsin | $45.49 |
| California | $45.03 |
| Connecticut | $44.97 |
Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (May 2025)
An insurance license in the states listed can unlock greater earning potential, as average wages in these areas are above the national mean of $39.18 an hour for insurance sales agents (May 2025). In the five best-paying areas (Washington, D.C., Massachusetts, New Jersey, New York, and Minnesota), the top insurer held an average of 47% of the large group market in 2024. Knowing which companies are leading the market in these states can help guide your employment decisions and enable you to make informed assessments regarding salary offerings.
How to become a health insurance agent
To begin a career as a licensed health insurance agent, you must meet your state’s licensing requirements and successfully pass the health or life and health insurance exam. While becoming an agent does not always require a college degree, coursework in business, finance, or marketing can provide a competitive edge and help prepare you for the licensing process.
As mentioned, a license is required in every state to legally sell products and policies. Insurance licensing requirements differ from state to state: some states require a set number of pre-licensing education hours, which can be completed online or in person, while others, such as Texas and (since January 1, 2026) California, don’t require a pre-licensing course, though California still requires 12 hours of study on ethics and the California Insurance Code. In many cases, the health insurance exam will also cover life insurance, allowing agents to offer both product types. Additional certifications, such as those for Medicare or specialized health insurance, can broaden expertise within the field.
The timeline for completing all health insurance license requirements varies based on your state’s regulations, but you can typically enter the insurance sector within a few months. By following these steps, you create a strong pathway for launching your career and advising clients on important coverage decisions.
Final thoughts
Before entering the world of health insurance, familiarize yourself with the top health insurance companies in your chosen state of practice. Understanding which insurers claim a sizable presence in your region will help you navigate both the career landscape and policy options, whether you choose to represent nationwide leaders like Kaiser or UnitedHealth or state-specific providers. Health insurance companies with a substantial market share will likely set the standard for employment opportunities, commission structures, and benefits available to agents in their respective areas.
Beyond knowing which companies operate in your state, you can get a sense of your overall earning potential and employment prospects by looking at job-related statistics. Researching top firms and average compensation by state can help you decide where to focus your licensing efforts. With this information, aspiring agents can make informed choices about where to work, factoring in company culture, agent salaries, and commission rates when evaluating health insurance careers. This strategic knowledge empowers you to identify the most suitable opportunities for success in a competitive market.
