If you find yourself diagnosed with an unexpected illness, you want a health insurance company that will provide a high level of care. While no health insurance company is perfect, you can find the best health insurance company for you by considering your needs, wants, and budget.
- Proprietary network of more than 1.1 million physicians and healthcare workers along with more than 3,000 hospitals.1
- Wellness programs include online weight loss support and rewards for reaching health goals.2
- Global services provide health coverage for expatriates.3
- Some wellness programs are only offered for employer-sponsored plans.4
- Claims may have to be submitted by the patient in some cases.5
- Centralized collaboration among medical professionals of all specialties can speed up diagnosis and coordinate treatment.6
- All adult members get free access to mental health and emotional wellness apps Calm and MyStrength.7
- Remote monitoring technology lets doctors track diabetes and hypertension in patients year-around.8
- Coverage only available in California, Colorado, Georgia, Hawaii, Maryland, Oregon Virginia Washington, and the District of Columbia.9
- Members must select medical care through the Kaiser Permanente network of doctors and specialists.10
- In some states, patients can have health care needs met at walk-in clinics.11
- Some plans offer 20% discount on CVS brand health care products.12
- Aetna offers Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans.13
- Claims process can be intricate including the need for a referral letter from your practitioner for certain services.14
- Health care providers outside of network may not be covered under some plans.15
- Individual ACA health plans only available in four states.16
- Largest Medicaid Managed Care Organization in the United States.17
- Has international presence through subsidiaries in Central Europe, Spain and the United Kingdom.18
- Relatively young company, founded in 1984.19
- Not available in all 50 states.20
- More than 67,000 contracted pharmacies in network.21
- More than 175,000 mental and behavioral health care providers in network.22
- More than 1.5 million relationships with global health care providers, facilities and clinics.23
- Individual and family health insurance plans only offered in 13 states.24
- Virtual/telehealth care not available for all health plans.25
- Coverage available in all 50 states, Washington DC and Puerto Rico.26
- Network includes more than 1.7 million doctors and hospitals.27
- BlueCross BlueShield consists of 35 independent companies, which may have different policies and procedures.28
- If you move to a new state, your BlueCross BlueShield insurer may change.29
Richard T. Burke founded Minneapolis-based3 UnitedHealth Group in 1977.4 UnitedHealth Group’s mission is “helping people live healthier lives and helping make the health system work better for everyone.” 5
UnitedHealth Group does business in every state6 through its subsidiaries, UnitedHealthcare and Optum,7 insuring approximately 46 million Americans. The company also ensures another 7.6 million people globally.8View Details
- AM Best: Financial Strength Rating of A.9 The highest rating is A+.10
- ACSI: 72 out of 10011 in 2020, down from 75 in 2019.12
- NAIC Complaint Index: In 2020 the highest number of complaints were for claim handling. There were 1,689 complaints on claim handling, with the top reason being ‘denial of a claim.’13
- NCQA: Scores vary in different regions. UnitedHealth Group plans scored as high as 4.5 out of 5 in Rhode Island and as low as 2.5 out of 5 in Nevada.14
- J.D. Power: Scores (on a scale of up to 1,000) vary in different regions. For example, UnitedHealthcare scored 738 in Florida and 690 in Illinois and Indiana.15
UnitedHealth Group’s mental health network has grown 48% in the past three years.31
Kaiser Permanente opened its doors in 1945 in response to healthcare challenges that grew out of the Great Depression.32 Founders Henry J. Kaiser and Sidney R. Garfield sought an affordable way to provide quality care.33
Kaiser Permanente operates in the District of Columbia and eight states: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington.34 The Oakland, California–based company insures approximately 12.5 million members.35 Kaiser Permanente’s subsidiaries are Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, and the Permanente Medical Groups.36View Details
- AM Best: Did not rate Kaiser Permanente.
- ACSI: 73 out of 10037 in 2020, down from 77 in 2019.38
- NAIC Complaint Index: In 2020, the highest number of complaints were for claim handling. There was three claim handling complaints with the top reason being delays in handling the claim.39
- NCQA: Scores vary by region. Kaiser Permanente scored as high as 5 out of 5 in the Mid-Atlantic region and as low as 4 out of 5 in Georgia.40
- J.D. Power: Scores (on a scale of up to 1,000) vary in different regions. For example, Kaiser scored 782 in customer satisfaction in California and 739 in Colorado.41
Kaiser Permanente’s charitable health coverage provides financial help if you don’t qualify for Medicaid or can’t afford private coverage. To qualify, you must live in Kaiser's service area and meet certain income requirements.50
Founded in 1853 as a life insurance company,51 Aetna today is one of the country’s largest providers of health benefits. Since 2018, the Hartfield, Connecticut–based52 organization has been a subsidiary company of CVS Health Corporation.53
While Aetna does not offer insurance for individuals and families,54 it offers group plans, such as through your employer,55 as well as Medicare, Medicaid, and international plans.56 The insurer has Medicaid plans in 14 states, primarily in the Northeast and the South.57 Aetna insures approximately 22.1 million members.58View Details
- AM Best: Financial Strength Rating of A.59 The highest rating is A+. 60
- ACSI: 71 out of 10061 in 2020, down from 76 in 2019.62
- NAIC Complaint Index: In 2020, the highest number of complaints were for claim handling. There were 37 complaints of claim handling with the top reason being ‘denial of claims.’63
- NCQA: Scores vary by region. Aetna scored as high as 4 out of 5 in Pennsylvania, Iowa, and Utah, and as low as 2.5 out of 5 in Mississippi and Nevada.64
- J.D. Power: Scores (on a scale of up to 1,000) vary by region. For example, Aetna scored 749 in Maryland and 718 in Ohio.65
- Aetna doesn’t have individual plans.
The Attain by Aetna app helps you work on personalized health goals.76
Centene Corporation made its mark as a nonprofit Medicaid plan when it was founded in 1984. Today it bills itself as the “largest Medicaid Managed Care Organization” in the United States.77 In addition, it offers health plans for those who don’t qualify for Medicaid.78
Centene’s subsidiaries include its Health Care Enterprise group and its Envolve family of companies.79 The company, based in St. Louis,80 also insures more than 25 million members in all 50 states.81View Details
- No ratings are available from any of the listed organizations.
Centene provides healthcare services to correctional facilities and government agencies.91
Cigna Corporation was formed from two other companies: The Insurance Company of North America (INA), founded in 1792, and the Connecticut General Life Insurance Company, founded in 1865.92 Today the company has a global footprint in more than 30 countries around the world.93
Cigna insures 17 million medical customers globally.94 In addition, Cigna offers health insurance products and services in every state.95 Cigna has several subsidiaries including Cigna Health and Life Insurance Company, Cigna Behavioral Health, and Loyal American Life Insurance Company.96View Details
- AM Best: Financial Strength Rating of A.97 The highest rating is A+.98
- ACSI: 71 out of 10099 in 2020, down from 72 in 2019.100
- NAIC Complaint Index: In 2020, the highest number of complaints were for claim handling. There were 456 complaints about claim handling with the top reason being ‘denial of claims.’101
- NCQA: Scores vary by region. Cigna scored as high as 4 out of 5 in Colorado, Connecticut, Maine, and Massachusetts, and as low as 2.5 in Nevada, New Mexico, Utah, Indiana, Kentucky, Louisiana, and Mississippi.102
- J.D. Power: Scores (on a scale of up to 1,000) vary by region. For example, Cigna scored 777 in Virginia and 697 in Colorado.103
Cigna’s workplace wellness coaching programs offer help for body and mind.116
Two companies — Blue Cross and Blue Shield — provided healthcare services in the early 1900s. In 1982, they joined to form one giant company, Blue Cross Blue Shield (BCBS).117
With headquarters in Chicago,118 the parent company licenses 35 independent, locally operated companies — including some of the largest healthcare insurers in the U.S., like Anthem and Independence Health Group — to provide BCBS insurance to their customers.119
Through the BCBS network, approximately 110 million consumers in all 50 states have coverage.120View Details
- AM Best: Ratings vary with different licensees. For example, Blue Cross Blue Shield of South Carolina received an A+ rating.121 The highest rating is A+.122
- ACSI: 72 out of 100123 in 2020, up from 71 in 2019.124
- NAIC Complaint Index: In 2020, the highest number of complaints were for claim handling. There were 37 complaints about claim handling with the top reason being ‘denial of claims.’125
- NCQA: Scores vary by region. Blue Cross Blue Shield scored as high as 4 out of 5 in Minnesota, Michigan, and North Carolina and as low as 3 out of 5 in Georgia and New York.126
- JD Power: Scores (on a scale of up to 1,000) vary by region. For example, Blue Cross and Blue Shield of Alabama scored 760 and Blue Shield of California scored 716.127
Blue365 offers discounts on health and wellness products.136
When looking for health insurance coverage, check out the company’s background to get an idea of its priorities. Also, look at its financial and customer satisfaction ratings to see what others think of the insurer. Then make sure the company offers the type of coverage that you need.
How Should You Shop for Health Insurance?
When shopping for a health policy, there are several factors to consider. Your location matters, as health plan offerings differ by state and region. Also, think about how often you intend to use healthcare services. If you have a chronic condition and visit the doctor regularly, you’d likely need a different type of plan than if you only had preventive care appointments. Finally, look at the financial and customer satisfaction ratings to determine the strength of the insurer.
When Can You Buy Health Insurance?
Typically, you can buy a health insurance plan during the open enrollment period, which takes place in the fall, generally, between November 1 and January 15.137 You may also be able to buy health insurance when you have a qualifying life event — for example if you have a baby or get married or divorced.
How Does Health Insurance Work?
Health insurance works by allowing you to budget for medical expenses so you don’t have to pay the entire cost out of your own pocket if a medical emergency occurs. You (or your employer) have a set amount to pay either monthly or when you access services through health insurance, and the health insurer pays the rest for covered services. By knowing how much you would be responsible for when accessing health services, you can be more financially prepared when you need care.
How Much Does Health Insurance Cost?
Health insurance consists of several different costs. A health insurance premium is an amount you pay your insurance provider each month, whether you go to the doctor or not.138 A deductible is the amount you pay when you receive covered healthcare services before your insurance kicks in.139 High-deductible plans require you to pay a higher deductible than other types of plans. Coinsurance is a percentage of covered health services that you must pay for while the insurer pays the rest.140 A copayment is a set amount you pay for covered services once your deductible has been reached.141
What Are the Ratings?
Ratings provide insight into a company’s financial strength and its reputation with customers. To evaluate insurers’ financial strength ratings, we checked with credit rating provider AM Best.1 For insight into customer service, we looked to the National Committee for Quality Assurance (NCQA — a health plan accreditation company),2 the American Customer Satisfaction Index (ACSI), and rating company J.D. Power. We turned to the National Association of Insurance Commissioners (NAIC) Complaint Index to understand customer complaints.
Health Plan Terms
When choosing a plan, make sure you understand the terms used to describe various aspects of plans. Here are some of the most common terms:
- Coinsurance: Coinsurance is the amount you pay for covered healthcare after you pay your deductible. For example, if a company calls for 20% coinsurance on $100, you would pay $20 to the doctor, while the insurance company pays the other $80.
- Deductible: A deductible is the amount you pay out of pocket before the health insurance company begins to cover claims.
- EPO: Exclusive provider organization, which allows you to choose your providers within a specific network. You can do so without choosing a primary care physician. However, you may not be able to use the insurance policy with out-of-network providers.
- HMO: Health maintenance organization, which is a managed care organization that negotiates with healthcare providers for lower prices. Often, HMOs restrict which providers you can use, while you may be assigned primary care doctors, as well as specialists.
- In-network: Providers who are part of your health insurance company’s network. These providers are cheaper because the providers agree to lower rates with your insurer.
- Out-of-network: Healthcare providers that aren’t in your insurance company’s network. You may have to pay more out of pocket if you go out-of-network, or the insurer may not cover any of your costs if you don’t choose an in-network provider.
- PPO: Preferred provider organization, which is a type of plan where you can choose your providers within a network. usually need to choose a primary care physician. It offers a little more flexibility than an HMO, and you might still be able to see out-of-network providers (at a higher rate).
We selected the health insurance companies with the highest market share and reviewed them by financial strength, customer satisfaction, and other factors, such as factual information on companies, including financials, customer satisfaction, complaints, geographic reach, pricing, and total insureds.
Choosing the right health insurer is not a decision that should be taken lightly. Take the time to do your research so you can find an insurer — and a plan — that won’t let you down.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.