GAO Report Finds Private Health Insurance Markets More Concentrated in 2024
Consumers in at least 36 states face limited insurer choice as three firms control 80% of enrollment, per GAO data through 2024.
The Government Accountability Office released its seventh periodic study of private health-insurance market concentration, examining the individual, small-group and large-group markets from 2011 through 2024.
GAO defines a market as concentrated when three or fewer issuers hold at least 80 percent of enrollment. The report finds that three or fewer insurers held at least 80 percent market share in at least 36 states for both the individual and employer-group markets, and that concentration in the individual market peaked in 2019 before slipping slightly.
Within the individual insurance exchanges, concentration rose from 47 states in 2015 to a peak of 51 states in 2020, then declined to 49 states in 2024.
Market-share calculations relied on enrollment data reported to the Centers for Medicare & Medicaid Services and state-collected data for 2015-2017, using the most recent two years of data available at the time of review. GAO provided a draft to the Department of Health and Human Services, which supplied technical comments that were incorporated into the final report.
The findings indicate that a small number of insurers dominate enrollment in many states, a condition that may limit consumer choice and influence premium levels.
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