10 Biggest HMOs in USA

The 10 biggest HMOs in USA are among the companies that strive to reduce your out-of-pocket medical costs and monthly premiums. HMO stands for Health Maintenance Organization, which is a medical insurance group providing health services for a fixed annual fee or a monthly premium. A HMO is a prepaid health plan which takes care of all the health requirements of an individual from an in-network provider.

Health maintenance organizations require that you select a primary care physician (PCP). A PCP is a personal doctor who provides all basic healthcare services and guides a person to a specialist if there is a need. The doctors serving under an HMO contract treat patients in accordance with the HMO’s guidelines. HMOs are ideal for employees who would like one doctor to coordinate all their medical care at predictable costs. They do not involve hassles of filing up claim forms; you just need to present a card at the doctor’s office or hospital.

Employers with 25 or more employees are required to offer certified HMO options to their employees under the Health Maintenance Organization Act of 1973. After that HMO companies started to expand and today people have the option choose from a variety. The 10 biggest HMOs in USA are key players in the US insurance industry. You might like to check out the 10 largest health insurance companies in America. With an increasing aging population and growing health awareness amongst people, the aggregate health expenditure is anticipated to follow a rising trend. According to a report, HMO’s contribution to the overall economy is expected to increase at 0.5% annually over the next five years.

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On the following pages is the list of 10 biggest HMOs in US ranked based on the total number of members.

10. Molina Healthcare, Inc. (NYSE:MOH) – 3.5 million

Started in 1980 by David Molina, Molina Healthcare, Inc. (NYSE:MOH) operates through three segments – health plans, Molina medicaid solutions and other. With a revenue of $14 billion in 2015, the company showed a net profit of $143 million. Its operates in 10 US states and Puerto Rico, and focuses on providing medicaid-related solutions to low income families. Molina provides minimum coverage HMO plans for members under 30, Silver 87 HMO with low premiums and Silver 94 HMO for people with yearly income between $16,000 – $18,000. In 2015, the company health plans served about 3.5 million people.

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We are continuing our list of biggest HMOs in USA with WellCare Health Plans that is a Florida-based health insurer which was founded in 1985. It partners with over 90,000 physicians and has a subscriber base of 3.8 million at the end of 2015. The company’s primary focus is on public healthcare plans such as Medicaid and Medicare. In order to expand its geographical coverage, WellCare has also bought a number of smaller medicare and medicaid providers over the last five years. WellCare HMO is a 2016 medicare advantage that includes additional medicare prescription drug (Part-D) coverage over and above hospital insurance (medicare Part A) and medical insurance (medicare Part B) coverage from WellCare.

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Centene Corp has been in the healthcare business since 1984. It has over 13,000 employees with a market capitalization value of $10.9 billion. Its segments include managed care segment and the specialty services segment. In 2016, the company merged with HealthNet in a $6 billion transaction. There are a wide range of HMO plans designed for various businesses. The HMO members are given an option to choose a primary care physician from its network for a fixed monthly fee. Many of its plans also include office visits, hospitalization, X-ray and lab services, prenatal and postnatal services, mental health services, and more.

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Kaiser Permanente is one of the largest non-profit health plans, operating across the U.S. for more than 60 years. Headquartered in Oakland, California, Kaiser Permanente had more than 11.3 million health plan members at the end of 2016. The firm had the largest number of members in California and employs more than 200,000 people. Kaiser HMO allows choosing from a wide range of care and support to control one’s health. Its plans focus mainly on preventive care services like routine physical exams, mammograms and cholesterol screenings at a cost depending on the plan.

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6. Humana Inc. (NYSE:HUM) – 14.2 million

Humana Inc. (NYSE:HUM), next in line on the list of biggest HMOs in USA, is a health care corporation that was founded 55 years ago. In 2015, Aetna Inc (NYSE:AET) announced that it would buy Humana for $37 billion, but the deal faced regulatory hurdles. Last month, a U.S. District Judge blocked the deal, saying that it would violate antitrust laws. Humana’s Gold Plus is a HMO plan including all the benefits of the original medicare and many other extra benefits. It offers more choices when it comes to finding a physician or even a specialist. Humana registered revenues of $54 billion in 2015 with a net profit of $1.27 billion. The company reported having 14.2 million members by the end of 2015.

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CIGNA Corporation (NYSE:CI) offers health, life and accident insurance products primarily in Asia, Europe and the United States. In 1982, the Connecticut General Life Insurance Company and INA Corporation merged to form CIGNA Corporation. Its HMO known as the Cigna Medical Group runs in Phoenix, Arizona. CIGNA reported revenues of $38 billion and a total global membership of 15 million people at the end of 2015. Similar to the previously-mentioned Humana and Aetna, in 2015, Anthem Inc (NYSE:ANTM) announced that it would acquire CIGNA and the deal was also blocked on antitrust grounds. However, both Anthem and CIGNA filed lawsuits against each other and Anthem recently won a temporary restraining order preventing CIGNA from officially terminating the deal.

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4. Aetna Inc. (NYSE:AET) – 23.48 million

Aetna, one of the biggest HMOs in USA, was founded in 1853 and headquartered in Connecticut U.S. The company reported $60 billion in revenues for 2015 with an operating income of $2.7 billion. Aetna offers health care, dental, pharmacy, group life and long term care insurance plans. The company has employer-paid insurance and benefit programs, and Medicare plans. Aetna’s HMO plan is simple – you choose a PCP from Aetna’s network, visit your PCP and pay your copay. The company had a total of 23,487,000 members at the end of December 2015.

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3. Anthem Inc. (NYSE:ANTM) – 38.6 million

WellPoint Medicare, number three on our list of biggest HMOs in USA is one of the largest health benefits companies in the United States. WellPoint Medicare plans are provided through WellPoint, now known as Anthem. Anthem and WellPoint Health Networks merged starting late 2004 and a series of subsequent mergers. Anthem Inc. (NYSE:ANTM) is one of the largest managed health care companies (for-profit) in the Blue Cross and Blue Shield Association. There are many different types of WellPoint HMOs and PPOs available, including Anthem Select Advantage, Blue Cross Senior Secure Plan and Anthem Medicare Preferred Standard. The total medical members stood at 38.60 million at the end of 2015.

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UnitedHealth Group is the largest US health insurer with a market value $155 billion and is based out of Minnetonka, Minnesota. UnitedHealthcare and Optum are the two subsidiaries of UnitedHealth Group, providing healthcare products and services. UnitedHealthcare Medicare Solutions offers Medicare Advantage plans that cover benefits in addition to those covered under Original Medicare. Its HMO plans enable members to receive care through a network of contracted local physicians and hospitals. Its cost is also lower than the other network-based plans. UnitedHealth serves approximately 70 million individuals throughout the U.S. and generated sales of over $157 billion in 2015.

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1. Blue Cross Blue Shield Association – 106 million 

With a total membership of 106 members, Blue Cross Blue Shield Association tops the list of 10 biggest HMOs in USA. It was formed by the merger of Blue Cross Association and Blue Shield in 1982. It is an alliance of 36 separate United States health insurance companies. Blue Cross Blue Shield Association provides health insurance plans under the government plans and private health coverage throughout the U.S. Its health maintenance organization comes under its managed care program, which provides hospital and medical care in one policy.

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