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Best’s Special Report: US Publicly Traded Health Insurers Sustain Revenue Growth Trend in 2023; Margins Likely to be Pressured in 2024

Publicly traded U.S. health insurance companies saw another year of growth, as total GAAP revenue rose in 2023 by 10.4% to $1.07 trillion. However, according to a new AM Best report, future results may be pressured as the profitability of government programs returns to more normal levels.

The new Best’s Special Report, titled, “Revenue Grows but Margins Are Pressured for US Publicly Traded Health Insurers,” states that half of the 10 publicly traded health insurers followed for this report reported double-digit premium growth in 2023, led by Oscar Health, Inc., at 46.9%; the population in aggregate also saw a 28.5% increase in investment income. Net income grew to $45.3 billion, a 6.8% increase over 2022, following a 12.5% spike in the previous year.

“With medical costs continue to rise across the United States, insurers have been raising premium rates and are likely to continue doing so in 2024 to maintain favorable earnings,” said Kaitlin Piasecki, industry research analyst, AM Best.

According to the report, Medicare Advantage (MA) earnings are being pressured by the decline in reimbursement rates from Centers for Medicare & Medicaid Services and an increase in medical claims and utilization. Medicaid managed care business already has begun to see a drastic decline in enrollment, which could be accompanied by a worsening of the risk pool as eligibility redeterminations are completed.

“Overall earnings for companies solely operating government programs could be challenged in 2024, but these companies should remain profitable,” said Jason Hopper, associate director, industry research and analytics, AM Best. “Medical management of those with chronic conditions, as well as quality programs and related bonus payments, will be extremely important for sustained earnings for these health plans. For plans operating in all business segments, commercial business margins will become a greater focus given the likely earning declines in Medicare Advantage and Medicaid managed care.”

To access the full copy of this special report, please visit

AM Best is a global credit rating agency, news publisher and data analytics provider specializing in the insurance industry. Headquartered in the United States, the company does business in over 100 countries with regional offices in London, Amsterdam, Dubai, Hong Kong, Singapore and Mexico City. For more information, visit

Copyright © 2024 by A.M. Best Rating Services, Inc. and/or its affiliates. ALL RIGHTS RESERVED.


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