The states with the least competitive commercial insurance markets | 2024

Almost half of the nation's local commercial insurance markets are majority controlled by one payer, according to the American Medical Association.

The AMA's annual "Competition in Health Insurance" report, published Nov. 19, found that 95% of metropolitan areas have "highly concentrated" commercial health insurance markets. In 89% of metropolitan areas, one payer has at least a 30% market share in combined HMO, PPO, point-of-sale and exchange markets. In 47% of markets, one insurer had a share of
50% or more.

These are the states where the largest payer controls more than half of the market:

Alabama
BCBS: 86% market share

Kentucky
Elevance: 67% market share

Michigan
BCBS: 67% market share

Louisiana
BCBS: 66% market share

Illinois
BCBS: 63% market share

Hawaii
BCBS: 63% market share

South Carolina
BCBS: 59% market share

Oklahoma
BCBS: 57% market share

Vermont
BCBS: 57% market share

Indiana
Elevance: 56% market share

Delaware
Highmark: 56% market share

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