In 2026, the top-earning health insurance companies in the US, based on projected revenue and market dominance, are led by UnitedHealth Group, with revenues projected between $450-$455 billion. Other top earners include Elevance Health (formerly Anthem), Centene Corporation, CVS Health (Aetna), and Kaiser Permanente.
Here are the top-earning and largest health insurance companies in the US for 2026:
United Health Group: Projected to remain the industry leader with massive revenue, offering extensive employer and global plans.
Elevance
Health (formerly Anthem): A dominant player with strong financial
outlooks, particularly in Blue
Cross Blue Shield-associated plans.
Centene Corporation: A major player, particularly in government-sponsored programs like Medicaid and the ACA Marketplace.
CVS Health (Aetna) A leading insurer with a major pharmacy benefit management (PBM) arm.
Kaiser Permanente: Known for its integrated care model and high revenue, particularly in individual and family plans.
Humana: A major competitor, particularly noted for its Medicare-focused coverage.
Cigna Health Group: A top earner with a strong focus on international employees and employer-based plans.
Health Care Service Corporation: A significant operator of Blue Cross Blue Shield plans.
Other notable top contenders for 2026 include Molina Healthcare (Medicaid/Medicare focus), Oscar Health (digital experience), and Blue Shield of California.
In 2026, the US health insurance market continues to be dominated by a few massive conglomerates. These companies generate revenue through a combination of insurance premiums, pharmacy benefit management (PBM), and direct healthcare services.
Top
Earning Health Insurance Companies (2026 Projections)
The following companies are the largest by revenue based on early 2026 guidance and 2025 year-end performance:
UnitedHealth Group (UnitedHealthcare): Remains the largest health insurer in the US. For 2026, the company expects full-year revenue to be greater than $439 billion.
CVS Health (Aetna): A massive integrated healthcare company. Its revenue, which includes Aetna's insurance business and its pharmacy services, exceeded $350 billion in 2025.
The Cigna Group: A major global player that projects significant earnings growth. In late 2025, its trailing twelve-month revenue was reported at approximately $268 billion.
Elevance Health (formerly Anthem): Expects a slight decline in 2026 operating revenue to just under $197.6 billion, primarily due to shifts in Medicaid enrollment.
Centene Corporation: A leader in government-sponsored programs (Medicaid/Medicare). Its TTM revenue reached roughly $155.6 billion as of early 2026.
Humana: Heavily focused on Medicare Advantage. It maintains a strong position with over $110 billion in annual premium income.
Kaiser Permanente: A major non-profit integrated managed care consortium. It reported approximately $94 billion in direct written premiums.
Key Market Drivers for 2026
Enrollment Shifts: Major insurers like Elevance Health are anticipating lower operating revenues due to fewer enrollments in Medicaid units.
Medicare Advantage: This sector remains a primary revenue driver, though proposed 2027 Medicare rates have already begun to impact stock valuations and long-term planning for 2026.
Consolidation: The top 10 insurers now control the vast majority of the commercial and Medicare Advantage markets, with many metro areas being highly concentrated.
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The top 10 health insurers are projected to earn a total of $1.6142 trillion in 2026.
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