Recent Trends in Commercial Health Insurance Market Concentration

Commercial health insurance markets remain highly concentrated across coverage types. However, the individual market, which primarily consists of the ACA markets, has attracted more insurers and witnessed greater competition among insurers across various measures since the implementation of enhanced premium tax credits in 2021, according to a new Healthy System Tracker analysis.

For example, from 2020 to 2023, the average market share of the largest insurer in each state’s individual market fell from 60% to 53%, consistent with enrollment growth in the ACA marketplaces driven by enhanced premium tax credits. In contrast, fully employer-insured health insurance markets have become less competitive over the past decade. The analysis presents enrollment and market competition data for the period 2013-2023 for fully insured and individual plans, both nationally and statewide.

The full analysis and other health care cost data are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and evaluating the performance of the U.S. health care system.