Health Insurance Markets Provide Fewer Choices For Enrollees

Why It Matters

Private health insurance market concentration generally increased from 2011 through 2024, leaving enrollees with potentially fewer insurer choices and higher premiums, according to a report by the Government Accountability Office, "Private Health Insurance: Market Concentration in 2024 Was Generally Higher Than in 2011," published Oct. 16. In at least 36 states, three or fewer insurers held at least 80 percent of enrollment in both the individual and employer-group markets, a threshold GAO uses to define a concentrated market. ​

The Big Picture

Private health insurance is the most common source of health insurance coverage in the United States, and a concentrated market may indicate less competition among issuers and could affect the choices and premiums consumers face. The Patient Protection and Affordable Care Act (PPACA) includes a provision directing GAO to periodically study health insurance market concentration.

Individual insurance exchanges, the marketplaces PPACA established where consumers can compare and select plans, have tracked the broader trend with some variation. Exchange markets were concentrated in 47 states in 2015, climbed to a peak of 51 states in 2020, then eased to 49 states in 2024.