54 things to know about 6 major US payers

Here are 54 key points about the major U.S. insurers — Aetna, Anthem, Blue Cross Blue Shield, Humana, Kaiser Permanente and UnitedHealth Group.

1. Headquarters — Hartford, Conn.

2. 2014 total revenue — $58 billion1

3. Mark T. Bertolini has served as chairman since 2011 and CEO since 2010.

4. Fortune 500 ranking — 49th1

5. Aetna has a membership of 23.5 million. The payer's network involves about 1.1 million healthcare professionals, more than 645,200 physicians and 5,653 hospitals.2

6. The payer's marketplace plans exist in Virginia, Pennsylvania, Ohio, Illinois, Florida, Washington, D.C., Delaware, Oklahoma, Texas and Arizona. The payer's PPO and HMO plans are competitive in most states, and its premiums are competitive in the East and Midwest.3

7. Pending mergers — On July 3, 2015, Aetna entered a definitive agreement to acquire Humana for a combination of cash and stock totaling $37 billion. The merger, set to close by the end of 2016, will result in a total of more than 33 million medical members. Humana stakeholders will receive $125 in cash and 0.8735 Aetna common shares for each Humana share.1

The Department of Justice is currently reviewing the acquisition. This merger, as well as the Anthem/Cigna merger, has sparked controversy among the American Medical Association and other organizations that believe the mergers will negatively impact competition in the insurance market.

8. Aetna did not renew its America's Health Insurance Plans membership for 2016, but plans to continue partnership with groups committed to high-quality, affordable healthcare.

9. Mr. Bertolini set an example when he raised the company's minimum wage to $16 per hour, which impacted 5,700 of Aetna's employees.1

1. Headquarters — Indianapolis

2. 2014 total revenue — $73.9 billion1

3. Joseph Swedish serves as CEO, chairman and president.

4. Fortune 500 ranking — 38th1

5. Anthem is the second largest payer in the United States and the largest for-profit healthcare company in the Blue Cross and Blue Shield Association. It serves 38.5 million members through its affiliated health plans and more than 72 million individuals through its subsidiaries. The payer serves consumers in 26 states.4

6. Anthem dominates the market share in 82 metropolitan areas, according to an American Medical Association study.5 The payer's rates are most competitive in Ohio, Indiana and the Midwest states.3

7. Anthem has exceeded its financial expectations for nine consecutive quarters.The payer expects its adjusted net income to increase from an estimated $10.16 per share in 2015 to more than $10.80 per share in 2016, according to Reuters. The payer has set the goal of attaining 40 million members and operating revenue exceeding $100 billion by 2018.4

8. Anthem faced a difficult start to 2015, with a cybersecurity attack that impacted nearly 80 million people. The hack, which was one of the largest data breaches disclosed by a healthcare company, exposed Anthem members' names, dates of birth and Social Security numbers.

9. Pending mergers — In July 2015, Anthem entered into a definitive agreement to acquire Cigna in late 2016. The transaction is valued at $54.2 billion. Following the merger, Anthem will have more than $115 million in pro forma annual revenues. The merged company will cover nearly 53 million members.

This merger, as well as the Aetna/Humana merger, has sparked controversy among the American Medical Association and other organizations that believe the mergers will negatively impact competition in the insurance market.

Blue Cross Blue Shield  
1. Headquarters — Chicago

2. Scott Serota has served as president and CEO of the Blue Cross Blue Shield Association since 2000.

3. Founded in 1929, Blue Cross and Blue Shield is the oldest payer group in the United States.6

4. The Blue Cross and Blue Shield System includes 36 independent, locally operated Blue Cross Blue Shield companies and the Blue Cross and Blue Shield Association.6

5. The payer serves about 105 million people across all 50 states, Washington, D.C., and Puerto Rico. Blue Cross Blue Shield companies are contracted with more than 96 percent of hospitals.6

6. The payer networks with 228,000 physicians and 570 local patient-centered programs.6

7. Blue Cross Blue Shield is the largest single processor of Medicare claims.6

8. The payer has enrolled 5.3 million U.S. federal employees, retirees and dependents in the Federal Employee Program. This program represents the largest single health plan group in the world.6

9. Blue Cross and Blue Shield is currently in the midst of two federal antitrust lawsuits in Alabama. The two cases involve healthcare providers and individual and small-employer customers who allege the Blue Cross and Blue Shied insurers are acting illegally by splitting up markets to avoid competition with each other. The case is still early in the process.

1. Headquarters — Louisville, Ky.

2. 2014 total revenue — $48.5 billion7

3. Bruce D. Broussard serves as Humana's CEO and president.

4. Fortune 500 ranking — 58th1

5. Humana ranks as the third largest payer, behind UnitedHealthcare and Anthem.3

6. The payer offers coverage in 22 states in the Midwest, Central plains and West.3

7. Humana is currently in the process of merging with Aetna (See merger details above under Aetna).

8. Humana reported it probably will not collect an adequate amount of money to cover the cost of individual plans by the time open enrollment closes. The payer predicts its Medicare Advantage plans will likely lose 120,000 to 125,000 members in 2016, and its commercial membership plans will probably decline by 200,000 to 300,000 by the end of 2016.

9. Humana will release its fourth quarter 2015 results on Feb. 10, 2016.

Kaiser Permanente
1. Headquarters — Oakland, Calif.

2. 2014 operating revenue — $56.4 billion8

3. Bernard J. Tyson serves as CEO of Kaiser Permanente.

4. Established in 1945, Kaiser Permanente includes the nonprofit Kaiser Foundation Health Plan and Hospitals and the for-profit Permanente Medical Groups.8

5. It is the nation's largest vertically integrated healthcare delivery system.8

6. The payer serves 10.1 million members and includes more than 17,000 physicians, 38 hospitals and 619 medical offices.8

7. It operates in California, Georgia, Oregon, Colorado, Hawaii, Maryland, Virginia, Washington and Washington, D.C. Ten million people receive coverage.8 

8. Kaiser Permanente plans to open a medical school in Southern California in 2019. The payer hopes to offer an education focused on integrated healthcare, and will not partner with any academic institution. The first class will most likely include 46 medical students.

9. Kaiser Permanente signed a definitive agreement to acquire Seattle-based Group Health Cooperative for $1.8 billion. The payer will establish a new nonprofit called Group Health Community Foundation, which will serve consumers on the West Coast from San Diego to Seattle. Kaiser expects the deal to close by late 2016.

UnitedHealth Group
1. Headquarters — Hopkins, Minn.

2. 2014 total revenue — $130.5 billion1

3. Stephen J. Hemsley has served as UnitedHealth Group's CEO and president since 2006.

4. Fortune 500 ranking — 14th1

5. UnitedHealth Group, comprised of UnitedHealthcare and Optum, represents the largest health insurer in the United States.1

6. UnitedHealth Group serves more than 85 million consumers in all 50 states and more than 125 countries.1

7. UnitedHealthcare rates are most competitive in urban and rural regions. The payer's copay plans prove popular. UnitedHealth Group holds a market share lead in 35 metropolitan areas.9

8. UnitedHealth Group projected its 2016 revenues will hit between $180 billion and $181 billion, and its net earnings of $7.10 to $7.30 per share. It estimates its 2016 cash flows from operations will be between $9.5 billion and $10 billion. The payer projected its 2015 net earnings will be $6.00 per share.

9. In June 2015, the payer decided to leave America's Health Insurance Plans, reporting a difference in interests.

1. Fortune, The 10 biggest health-care companies in the Fortune 500
2. Aetna Facts
3. List of Top Health Insurance Companies
4. Anthem
5. Dark Daily, AMA study
6. BlueCross BlueShield
7. Humana
8. Kaiser Permanente
9. American Medical Association

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast