United States Health and Medical Insurance Market Analysis 2021-2026

Dublin, December 31, 2021 (GLOBE NEWSWIRE) – The “United States Health and Medical Insurance Market – Growth, Trends, Impact of COVID-19, and Forecast (2021-2026)” the report was added to ResearchAndMarkets.com offer.

The US health insurance market is the largest in the world, without adhering to the WHO universal health coverage. Although 8% of the American population does not have health insurance, the United States continues to dominate the growth in health insurance premiums in North America. This growth can be attributed to medical inflation, increased employment, and some postponement of benefits from the health policies of former US President Obama and Trump. According to cdc.gov – Center for Disease Control and Prevention, the United States spent $ 3.8 trillion in 2019, or nearly 17.7% of the country’s GDP, bringing the average health expenditure per person in the states United at $ 11,582, which has crossed the $ 12,000 mark. in 2020. The United States government has implemented extensive health care legislation to provide health coverage to the majority of the American population.

According to the National Association of Insurance Commissioners (NAIC), over 68% of health care coverage was provided by private insurance programs, such as PPOs, HMOs, POS plans, etc. The top 25 insurers in the United States accounted for around USD 130 billion in 2019, of which over 60% came from the top 25 health insurers. About 6% of Americans have non-group health insurance, and 50% have employer-provided insurance, 35% have Medicaid or Medicare and Military insurance while over 9% are still uninsured in 2019 .

Drivers: Highlights

  • Increase in total health expenditure, which includes both public and private expenditure on health promotion and disease prevention programs, with the use of medical, paramedical and nursing knowledge and technology

  • Growth in overall employment increases demand for health insurance through individual and employer-sponsored health coverage

Constraints: highlights

  • Government regulations and related political orders are making many unprecedented changes in the way health care coverage is offered to U.S. citizens.

  • Expensive health insurance and even expensive treatment have seen no improvement, even after repeated state intervention due to the heavily privatized sector.

Key market trends

High deduction health plans are gaining popularity with the public

These are plans with a higher deductible than any traditional insurance plan. The monthly premium is usually lower, but more health care costs are paid before the insurance company starts paying its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money without federal tax. The IRS defines a high-deductible health plan as any plan with a deductible of at least $ 1,350 for an individual, or $ 2,700 for a family. The total annual disbursements of an HDHP (including deductibles, co-payments and coinsurance) cannot exceed $ 6,650 for an individual or $ 13,300 for a family (not applicable to off-grid services) .

The number of registrations for these plans continues to grow year over year as many employees feel the need to fight rising healthcare prices. The increasing consumerization can continue to drive the huge growth of voluntary benefits among employees, and as a result, HDHPs are gaining in popularity, in order to manage costs. The large group market with more than 50 employees remains the most popular setting for HDHP and HAS registration, according to AHIP. In 2017, 82% of registrations took place with large employers, followed by the small employer market (11%) and the personal market (7%).

ACA and Health

0.7 million people were covered by the health insurance markets created under the ACA, including 9.2 million who received premium tax credits and 5.3 million who received reductions cost sharing. In Florida, Mississippi, Alabama, Nebraska, and Oklahoma, at least 95% of market registrants receive premium tax credits and / or cost-sharing grants.

Insurers can no longer deny coverage for pre-existing conditions, charge higher premiums based on health or gender, revoke coverage when someone becomes ill, or impose annual or lifetime limits. About 54 million people have a pre-existing condition that could have barred them from coverage in the pre-ACA individual market. Private insurers must now cover a wide range of preventive services at no cost to consumers. This includes recommended cancer and chronic disease screenings, vaccinations, and other services. Almost 150 million people are affiliated with employer plans or individual market insurances which must provide these preventive services free of charge.

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

About 60% of the American population uses private health insurance services to take care of their health needs. Private health insurance generally covers people not covered or partially covered by a public health program. Trump Care had its benefits, it planned to reduce the federal deficit by $ 150 billion by 2026. Trump Care increased health savings account (HSA) contributions from $ 3,400 to $ 6,550. – the existing conditions and the repeal of the consumption tax on prescription drugs, medical devices and certain medical plans.

According to the US Census Bureau, in 2018 private health insurance coverage stood at 68%, significantly higher than government coverage (32%). In the different segments of health insurance coverage, employer-based insurance was the most common, which covered around 56% of the population for a few months, or all year, followed by Medicaid (19.3 %), Medicare (17.2%), direct purchase coverage (16.0%) and military coverage (4.8%). Growth in private health insurance spending is expected to have increased by 0.5%, to 5.6%, in 2017, in part due to higher premiums in the health insurance market. However, spending is expected to slow by 0.7%, on average, for 2019-2020.

Competitive landscape

According to a report by the American Medical Association (or AMA), the private health insurance industry is highly concentrated, with 72% of total metropolitan areas not having significant competition among health insurers.

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 the share of a market controlled by each of the competing companies (market share) and is expressed by a value between zero and 10,000. The lower the number, the larger the market. competitive. The higher concentration of mergers and acquisitions 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 consolidation, which gives them leverage to raise and keep premiums above competitive levels.

Most M&A activity is focused on insurance companies partnering with PBMs to manage rising health care costs. Few examples include the merger of CVS with Aetna ($ 69 billion). The merger combines CVS’s pharmacies with Aetna’s insurance business, in the hope of lowering costs. Cigna and Express Scripts have entered into a US $ 67 billion merger to reduce healthcare costs and achieve better results. Walmart and Humana, who previously partnered with a low-cost Medicare Part D prescription drug plan, have an impressive array of medical retail capabilities – PBM – focused on the growing insurance market. sickness.

Key topics covered

1.1 Study deliverables
1.2 Study hypotheses
1.3 Scope of the study



4.1 Market overview
4.1.1 Dissertation on health insurance premiums and study on the effect of the medical trend rate on health insurance plans
4.1.2 Online Health Insurance Sales Growth Overview and Growth Prospect in Health Insurance Industry
4.1.3 Technological advancement and innovation in the health insurance sector
4.2 Regulations and government initiatives
4.2.1 Note on the Patient Protection and Affordable Care Act (ACA, Trumpcare) and its implications for comprehensive health insurance coverage
4.2.2 Insights on the latest health policy changes and their effect on the health spending of U.S. citizens
4.3 Market drivers
4.4 Market restrictions
4.5 Porters 5 force analysis
4.6 Impact of Covid-19 on the US Medicare and Medicare Market.

5.1 By type of supply
5.1.1 Purchased directly / individually
5.1.2 Employer-based Small group market Large groups market
5.2 By products and services offered
5.2.1 Management of pharmaceutical benefits
5.2.2 High deductible health plans
5.2.3 Free plans
5.2.4 Managed care plans
5.3 By place of purchase
5.3.1 On Exchange / Marketplace
5.3.2 Off-exchange / market

6.1 Supplier market share
6.2 Mergers & Acquisitions
6.3 Company profiles
6.3.1 UnitedHealth Group
6.3.2 Anthem
6.3.3 Humana Group
6.3.4 Health Services Group Inc.
6.3.5 Centene Company
6.3.6 Aetna Inc.
6.3.7 Kaiser Foundation Group
6.3.8 Independence Health Group
6.3.9 Molina Health


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