Explore top health insurance companies by state
In the U.S., over 40% of people with health insurance are covered by one of five major providers. 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 recent data, the three top insurers in the U.S. by enrollment in 2023 were Kaiser Permanente, UnitedHealth, and Elevance (formerly Anthem). These companies dominate the large group or employer-sponsored insurance segment, the largest market subset of the health insurance industry. Leading the nation was Kaiser, which enrolled over 7 million members in its health insurance plans that year, holding an impressive 18% market share nationwide.
| Insurer name | Enrollment | Market share |
|---|---|---|
| Kaiser Permanente | 7,020,278 | 18% |
| UnitedHealth Group | 4,709,993 | 12% |
| Elevance Health Group | 3,405,588 | 9% |
UnitedHealth secured the second position, reaching a national enrollment of 4.7 million members and claiming a 12% market share. Elevance Health was the third-largest health insurance carrier in the U.S., holding 9% of the market and serving 3.4 million people through its 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 by these providers. Enrollment data reflect the number of people who were covered under comprehensive major medical insurance and mini-med plans offered by these carriers.
BlueCross BlueShield (BCBS) and its licensees stood out as the top health insurance companies across the greatest number of states, maintaining a leading market share in 25 areas. The BlueCross name is shared by a federation of independently owned, locally operated organizations, which may account for its extensive reach. Other major contenders among top health insurance companies include Elevance Health (with a significant presence in 6 states) and Kaiser Permanente (heavily represented in 5). Health Care Service Corporation (HCSC), also part of the BCBS system, enrolls the most people in 5 states.
In some areas, a single company insures the majority of people: in Wyoming, BCBS controlled over 91% of that state’s individual market. Other markets, by contrast, are more varied: in New York, CVS Health (Aetna) enrolled just 17% of insured residents, reflecting a broader distribution of carriers.
In California, over 5 million residents were enrolled with Kaiser Permanente, the state’s largest health insurance company. Over 50% of the insured population was covered by Kaiser plans in the country’s most populous state. Notably, nearly 75% of the company's policyholders are located in California alone, 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 highest employment rates of insurance 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 |
|---|---|
| Texas | 44,670 |
| Florida | 44,080 |
| California | 41,150 |
| New York | 20,990 |
| North Carolina | 19,540 |
| Georgia | 19,520 |
| Illinois | 17,640 |
| Pennsylvania | 17,600 |
| Ohio | 15,750 |
| Virginia | 14,09 |
Source: U.S. Bureau of Labor Statistics (2024)
These elevated employment numbers underscore the ongoing demand for licensed agents in these states, although competition among professionals may be more intense. Four of the top states, California, New York, Georgia, and Illinois, also report some of the highest average hourly salaries for insurance agents in the industry:
| State | Hourly mean wage |
|---|---|
| District of Columbia | $51.25 |
| New York | $50.72 |
| Massachusetts | $49.05 |
| Connecticut | $48.54 |
| New Jersey | $48.13 |
| Minnesota | $47.22 |
| Illinois | $46.54 |
| Alabama | $44.10 |
| California | $44.05 |
| Georgia | $43.89 |
Source: U.S. Bureau of Labor Statistics (2024)
An insurance license in the states listed can unlock greater earning potential, as average reported salaries in these areas are above the national mean of $39.19 for sales agent roles. In the five states with the highest salaries (DC, New York, Massachusetts, Connecticut, and New Jersey), the mean market share for the top insurer was 40%. 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 fulfill specific education and training requirements and successfully pass the 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: most states require a set number of pre-licensing education hours, which can be completed online or in person. 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.
