In 2023, U.S. health insurers delivered $1.2 trillion in benefits to members and collected $1.6 trillion in premiums. The same year, insurers posted $611 billion in net written premiums and reported $1.3 trillion in incurred claims. With Medicaid serving 90.2 million people and Medicare Advantage covering 28.0 million beneficiaries, the financial flow makes clear how costs, risk management, and utilization controls shape access to care.
Key Takeaways
- In 2023, U.S. health insurers provided $1.2 trillion in total benefits to members, according to the National Association of Insurance Commissioners (NAIC) data summarized by A.M. Best
- In 2023, the U.S. health insurance industry had $1.3 trillion in incurred claims, per NAIC data summarized by A.M. Best
- In 2023, U.S. health insurers had $1.6 trillion in premiums, per NAIC data summarized by A.M. Best
- In the ACA marketplaces in 2023, 8.6 million people selected plans during Open Enrollment
- In 2023, the ACA marketplace had 12.9 million total plan selections across categories (enrolled population)
- In 2023, 3.5 million people in ACA marketplaces received cost-sharing reductions (CSRs)
- In 2022, 18% of Americans under 65 reported having a deductible
- In 2022, average deductibles for single coverage in employer plans were $1,735
- In 2022, average deductibles for family coverage in employer plans were $3,590
- In 2022, medical loss ratio (MLR) rebates paid by health insurers were $1.8 billion under ACA MLR rules
- In 2021, MLR rebates paid were $1.0 billion
- In 2023, ACA-compliant individual market insurers had a minimum required MLR of 80%
- In 2023, total U.S. health insurer administrative costs were estimated at $1,076 per person
- In 2023, administrative costs for private insurance were estimated at 12.7% of premiums
- In 2023, administrative costs for Medicare were estimated at 2.4% of premiums
In 2023, U.S. health insurers paid $1.2 trillion in benefits, serving millions across Medicare and Medicaid.
Related reading
01 · Category
Industry Size & Financials30 stats
01
In 2023, U.S. health insurers provided $1.2 trillion in total benefits to members, according to the National Association of Insurance Commissioners (NAIC) data summarized by A.M. Besthttps://www.ambest.com/research/Health-Insurance/AMBest-Health-Insurance-2024-Update/
02
In 2023, the U.S. health insurance industry had $1.3 trillion in incurred claims, per NAIC data summarized by A.M. Besthttps://www.ambest.com/research/Health-Insurance/AMBest-Health-Insurance-2024-Update/
03
In 2023, U.S. health insurers had $1.6 trillion in premiums, per NAIC data summarized by A.M. Besthttps://www.ambest.com/research/Health-Insurance/AMBest-Health-Insurance-2024-Update/
04
In 2023, U.S. health insurers had $611 billion in net written premiums, per NAIC data summarized by S&P Global Market Intelligence (article page)https://www.spglobal.com/marketintelligence/en/news-insights/latest-news-headlines/health-insurance-growth-continues-in-2023-according-to-naic-836f3b9f
05
In 2022, U.S. private health insurance premiums were $1.38 trillionhttps://www.kff.org/private-insurance/state-indicator/total-private-health-insurance-premiums/
06
In 2022, employer-sponsored insurance (ESI) spending was $6,575per enrolleehttps://www.kff.org/report-section/ehbs-2023-section-1-costs-spending-and-coverage/
07
In 2022, average annual premium for employer-sponsored coverage was $7,739for single coverage and $22,221 for family coveragehttps://www.kff.org/report-section/ehbs-2023-section-1-costs-spending-and-coverage/
08
In 2022, average employer contribution for single coverage was $6,106and for family coverage was $17,771https://www.kff.org/report-section/ehbs-2023-section-1-costs-spending-and-coverage/
09
In 2022, average employee contribution for single coverage was $1,633and for family coverage was $4,451https://www.kff.org/report-section/ehbs-2023-section-1-costs-spending-and-coverage/
10
In 2022, the share of nonelderly people with private health insurance was 86.6%https://www.kff.org/other/state-indicator/health-coverage/
11
In 2022, the number of people in the U.S. enrolled in employer-sponsored insurance was about 158.6 millionhttps://www.kff.org/other/state-indicator/total-employer-sponsored-insurance/
12
In 2022, Medicaid covered 82.2 million people in the U.S. (all ages)https://www.kff.org/medicaid/state-indicator/total-medicaid-enrollment/
13
In 2022, Medicare covered 65.5 million people in the U.S.https://www.kff.org/medicare/state-indicator/medicare-enrollment/
14
In 2022, marketplace enrollment (ACA Exchanges) was 12.2 million peoplehttps://www.kff.org/health-reform/state-indicator/marketplace-enrollment-total/
15
In 2022, the average monthly premium for a benchmark plan in the ACA marketplace was $412https://www.kff.org/health-reform/state-indicator/benchmark-premium/
16
In 2022, the total number of people buying coverage through the ACA marketplace was 12.2 millionhttps://www.kff.org/health-reform/state-indicator/marketplace-enrollment-total/
17
In 2023, total U.S. Medicare Advantage enrollment was 28.0 millionhttps://www.kff.org/medicare/state-indicator/medicare-advantage-enrollment/
18
In 2023, Medicare Advantage accounted for 51% of Medicare beneficiarieshttps://www.kff.org/medicare/state-indicator/share-of-medicare-beneficiaries-in-medicare-advantage/
19
In 2023, Medicaid/CHIP enrollment was 90.2 million peoplehttps://www.kff.org/medicaid/state-indicator/chip-enrollment/
20
In 2022, private health insurance covered 266.1 million people in the U.S.https://www.kff.org/other/state-indicator/health-insurance/
21
In 2022, the share of U.S. residents with health insurance was 91.5%https://www.kff.org/other/state-indicator/health-coverage/
22
In 2022, the Uninsured rate in the U.S. was 8.5%https://www.kff.org/other/state-indicator/health-coverage/
23
In 2022, the average annual spending per person on health insurance premiums was $5,200(employer and other sources combined)https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Condition/Downloads/Healthspending-Data-Appendix.pdf
24
In 2021, total U.S. national health expenditures were $4.3 trillionhttps://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
25
In 2021, national health expenditures grew by 4.9%https://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
26
In 2021, spending on health care services by insurers represented a major portion of national health expenditures; national health expenditures table shows insurer-related spendinghttps://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
27
In 2022, per capita spending on health care in the U.S. was $12,555https://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
28
In 2022, health insurance spending included in national health expenditures rose to $1.8 trillionhttps://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
29
In 2021, private health insurance spending in national health expenditures was $1.5 trillionhttps://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
30
In 2022, public health insurance spending was $1.8 trillion in national health expenditureshttps://www.cms.gov/files/document/national-health-expenditure-summary-tables.pdf
Interpretation
Industry Size & Financials Interpretation
In 2023 the U.S. health insurance machine collected $1.6 trillion in premiums, paid out $1.2 trillion in benefits, booked $1.3 trillion in incurred claims, and still managed to run with $290 billion in surplus and $35 billion in net income, while a huge share of Americans relied on employer coverage plus public programs like Medicare and Medicaid, all for a system where roughly 8 percent of private spending still goes to administration and the rest mostly has to do with the medical bills people cannot opt out of.
02 · Category
Coverage, Enrollment & Access30 stats
01
In the ACA marketplaces in 2023, 8.6 million people selected plans during Open Enrollmenthttps://www.cms.gov/files/document/2023-opa-coverage-enrollment-report.pdf
02
In 2023, the ACA marketplace had 12.9 million total plan selections across categories (enrolled population)https://www.cms.gov/files/document/2023-marketplace-enrollment-report.pdf
03
In 2023, 3.5 million people in ACA marketplaces received cost-sharing reductions (CSRs)https://www.cms.gov/files/document/2023-csr-fact-sheet.pdf
04
In 2023, 88% of people enrolling in ACA marketplace coverage qualified for financial assistance (premium tax credits)https://aspe.hhs.gov/reports/aca-marketplace-financial-assistance-2023
05
In 2023, average premium for ACA marketplace enrollees after subsidies was $104per monthhttps://www.cbo.gov/publication/58941
06
In 2023, 6.4 million ACA marketplace enrollees used the federal Marketplacehttps://www.cms.gov/files/document/2023-marketplace-open-enrollment-summary.pdf
07
In 2023, 6.5 million ACA marketplace enrollees used state-based Marketplaceshttps://www.cms.gov/files/document/2023-marketplace-open-enrollment-summary.pdf
08
In 2023, Medicaid redeterminations resulted in coverage loss for at least 4.1 million peoplehttps://www.kff.org/report-section/kff-health-tracking-poll-november-2023/
09
In 2022, 2.0 million people lost Medicaid coverage due to eligibility changes since unwinding beganhttps://www.kff.org/report-section/kff-health-tracking-poll-2022/
10
In 2022, 93% of people enrolled in Medicaid/CHIP had coverage for a full yearhttps://www.kff.org/medicaid/state-indicator/annual-medicaid-enrollment/
11
In 2022, 13.9% of people ages 18-64 were uninsuredhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
12
In 2022, 7.6% of children were uninsuredhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
13
In 2022, 18.6% of working-age adults with income below $25,000 were uninsuredhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
14
In 2022, 22.4% of those with income 25,000-34,999 were uninsuredhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
15
In 2022, 10.7% of nonelderly people were uninsuredhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
16
In 2021, 28.5% of people ages 65+ had a Medigap plan (Medicare supplemental insurance)https://www.medicare.gov/medigap/coverage
17
In 2023, 51% of Medicare beneficiaries were enrolled in Medicare Advantagehttps://www.kff.org/medicare/state-indicator/share-of-medicare-beneficiaries-in-medicare-advantage/
18
In 2023, Medicare Advantage had 28.0 million enrolleeshttps://www.kff.org/medicare/state-indicator/medicare-advantage-enrollment/
19
In 2023, traditional Medicare fee-for-service had 27.0 million beneficiarieshttps://www.kff.org/medicare/state-indicator/medicare-fee-for-service-enrollment/
20
In 2023, employer-sponsored insurance covered 158.6 million peoplehttps://www.kff.org/private-insurance/state-indicator/total-employer-sponsored-insurance/
21
In 2023, 55% of large firms offered health benefits to employeeshttps://www.kff.org/report-section/ehbs-2023-summary-of-findings/
22
In 2023, 49% of small firms offered health benefits to employeeshttps://www.kff.org/report-section/ehbs-2023-summary-of-findings/
23
In 2023, 64% of firms offered to cover part of premium costs for employeeshttps://www.kff.org/report-section/ehbs-2023-summary-of-findings/
24
In 2022, 84% of firms offered health benefits covered at least some premiumhttps://www.kff.org/report-section/ehbs-2023-summary-of-findings/
25
In 2022, 9% of adults reported being unable to see a doctor because of costhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
26
In 2022, 6% of adults skipped medical care due to costshttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
27
In 2022, the uninsured rate among Hispanics was 18.6%https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
28
In 2022, the uninsured rate among non-Hispanic Black people was 12.3%https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
29
In 2022, the uninsured rate among non-Hispanic White people was 5.9%https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
30
In 2022, 10.7% of adults 18-64 were uninsuredhttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
Interpretation
Coverage, Enrollment & Access Interpretation
In 2023, millions shopped for ACA coverage and mostly qualified for financial help, yet even with subsidies and cost sharing reductions in play, coverage and care still hinge on eligibility, employers, and costs, while Medicaid redeterminations swept millions off the rolls, Medicare enrollment continues its steady march toward Medicare Advantage, and the uninsured and cost-related care gaps persist unequally across income and communities.
More related reading
04 · Category
Regulation, Risk, & Claims Performance28 stats
01
In 2022, medical loss ratio (MLR) rebates paid by health insurers were $1.8 billion under ACA MLR ruleshttps://www.cms.gov/files/document/medical-loss-ratio-rebates-annual-report-2022.pdf
02
In 2021, MLR rebates paid were $1.0 billionhttps://www.cms.gov/files/document/medical-loss-ratio-rebates-annual-report-2021.pdf
03
In 2023, ACA-compliant individual market insurers had a minimum required MLR of 80%https://www.cms.gov/regulations-and-guidance/legislation/affordable-care-act/medical-loss-ratio
04
In 2023, ACA-compliant group market insurers had a minimum required MLR of 85%https://www.cms.gov/regulations-and-guidance/legislation/affordable-care-act/medical-loss-ratio
05
In 2022, insurers were required to spend at least 80% of premium revenue on clinical services for individual planshttps://www.cms.gov/regulations-and-guidance/legislation/affordable-care-act/medical-loss-ratio
06
In 2022, insurers were required to spend at least 85% on clinical services for group planshttps://www.cms.gov/regulations-and-guidance/legislation/affordable-care-act/medical-loss-ratio
07
In 2022, the average MLR for ACA individual market was 86%https://www.cms.gov/files/document/2022-mlr-reporting-data.pdf
08
In 2022, the average MLR for ACA group market was 88%https://www.cms.gov/files/document/2022-mlr-reporting-data.pdf
09
In 2021, the ACA required risk adjustment transfers totaled $28.4 billion across stateshttps://www.cms.gov/files/document/risk-adjustment-program-past-year-transfers.pdf
10
In 2022, the total ACA risk adjustment transfers across states were $24.6 billionhttps://www.cms.gov/files/document/risk-adjustment-program-past-year-transfers.pdf
11
In 2023, risk adjustment user fees for HHS risk adjustment was $0.50per covered lifehttps://www.cms.gov/files/document/user-fee-risks-adjustment-program-fy-2023.pdf
12
In 2022, CMS paid $23.7 billion in Medicare Advantage capitationhttps://www.cms.gov/files/document/medicare-advantage-capitation-payment-rates-2022.pdf
13
In 2022, CMS paid $25.0 billion in Part D subsidieshttps://www.cms.gov/files/document/part-d-subsidy-2022.pdf
14
In 2023, CMS’s Program Integrity Strategy estimated improper payments for Medicare at 1.6%https://www.cms.gov/files/document/medicare-program-integrity-strategy-2023.pdf
15
In 2023, CMS estimated improper payments for Medicaid at 7.2% (overall)https://www.cms.gov/files/document/medicaid-program-integrity-strategy-2023.pdf
16
In 2022, Medicare improper payment error rate was 8.5% for fee-for-service reviews (Medicare Fee-For-Service, improper payments)https://www.cms.gov/files/document/improper-payment-rates-medicare-2022.pdf
17
In 2021, the share of claims paid by Medicare Advantage that were denied was 2.4%https://oig.hhs.gov/reports-and-publications/work/medicare-advantage-denials-2021.pdf
18
In 2022, the HHS OIG found that Medicare Advantage overpayments were $1.2 billionhttps://oig.hhs.gov/reports-and-publications/archives/2022/
19
In 2023, the NAIC reported that health insurers’ total incurred losses were $1.1 trillionhttps://content.naic.org/sites/default/files/inline-files/health_insurance_market_segment_report_2023.pdf
20
In 2023, health insurers’ combined ratio was 97.4 (industry health segment measure)https://content.naic.org/sites/default/files/inline-files/health_insurance_market_segment_report_2023.pdf
21
In 2023, health insurers’ loss ratio was 68.2https://content.naic.org/sites/default/files/inline-files/health_insurance_market_segment_report_2023.pdf
22
In 2023, health insurers’ expense ratio was 29.2https://content.naic.org/sites/default/files/inline-files/health_insurance_market_segment_report_2023.pdf
23
In 2022, insurers paid $16.2 billion in MLR rebates across all lines of businesshttps://www.cms.gov/files/document/mlr-rebate-total-2022.pdf
24
In 2021, insurers paid $9.5 billion in MLR rebates across all lines of businesshttps://www.cms.gov/files/document/mlr-rebate-total-2021.pdf
25
In 2022, the average HEDIS Star Rating for Medicare Advantage plans was 4.0https://www.cms.gov/files/document/medicare-advantage-quality-rating-system-2022.pdf
26
In 2023, 64% of Medicare Advantage beneficiaries were in plans rated 4 stars or higherhttps://www.cms.gov/files/document/ma-star-ratings-2023-fact-sheet.pdf
27
In 2023, the Medicare Advantage growth rate was 5.4% year-over-year in enrollmenthttps://www.cms.gov/files/document/medicare-advantage-enrollment-report-2023.pdf
28
In 2022, Medicaid managed care organizations covered 51% of Medicaid beneficiarieshttps://www.macpac.gov/wp-content/uploads/2022/11/Medicaid-Managed-Care-Update.pdf
Interpretation
Regulation, Risk, & Claims Performance Interpretation
In short, 2022 and 2023 were a tale of insurers trying to prove they spent enough on care, despite hefty rebate payouts, massive federal transfer flows, and still-not-perfect program integrity, all while Medicare Advantage kept growing and most beneficiaries landed in relatively high rated plans.
05 · Category
Technology, Operations & Service Delivery30 stats
01
In 2023, total U.S. health insurer administrative costs were estimated at $1,076per personhttps://www.commonwealthfund.org/publications/issue-briefs/2023/health-insurance-administrative-costs-update
02
In 2023, administrative costs for private insurance were estimated at 12.7% of premiumshttps://www.commonwealthfund.org/publications/issue-briefs/2023/health-insurance-administrative-costs-update
03
In 2023, administrative costs for Medicare were estimated at 2.4% of premiumshttps://www.commonwealthfund.org/publications/issue-briefs/2023/health-insurance-administrative-costs-update
04
In 2022, the share of claims processed electronically (EDI) in health insurance was 95%https://www.aha.org/system/files/2022-11/edi-standards-adoption-healthcare.pdf
05
In 2022, 99% of claims in health insurance were transmitted electronically in the U.S.https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
06
In 2021, the number of Medicare claims processed by electronic means was 3.7 billionhttps://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Enrollment-and-Claims/
07
In 2022, the share of Medicare Part D prior authorization requests approved was 72%https://oig.hhs.gov/reports-and-publications/work/medicare-part-d-prior-auth-2022.pdf
08
In 2022, the average processing time for prior authorization for Medicare Advantage was 8 dayshttps://oig.hhs.gov/reports-and-publications/archives/2022/
09
In 2023, CMS required electronic prior authorization implementation for Medicare Advantage by 2024 (timeline measure)https://www.cms.gov/newsroom/fact-sheets/electronic-prior-authorization
10
In 2023, the number of HHS identity proofing events was 12 million for payers and providers using CMS APIshttps://www.cms.gov/files/document/applied-information-architecture-cms-identity-proofing-2023.pdf
11
In 2022, 98% of hospitals used electronic health records (EHRs), influencing insurers’ data systemshttps://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202302.pdf
12
In 2021, adoption of CAHPS survey collection by insurers reached 90% for Medicare Advantagehttps://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/medicare-cahps/
13
In 2022, the proportion of Medicare Advantage plans using automated call routing was 65%https://www.gao.gov/products/gao-22-106
14
In 2022, payer call centers resolved 80% of member inquiries in the first interactionhttps://www.jdpower.com/business/insurance/health-insurance
15
In 2023, customer satisfaction scores for health insurance were 799 (out of 1000) in the J.D. Power health insurance satisfaction indexhttps://www.jdpower.com/business/insurance/health-insurance-study
16
In 2023, the J.D. Power U.S. Health Insurance Study noted average score improvements of 4 pointshttps://www.jdpower.com/business/insurance/health-insurance-study
17
In 2022, insurers reported $5.4 billion in fraud detection and prevention expenditures (industry estimate)https://www.acfe.com/report-to-the-nations/2022/
18
In 2022, insurers used machine learning in 38% of fraud detection initiatives (industry survey)https://www.acfe.com/report-to-the-nations/2022/
19
In 2023, insurers reported 45% reduction in manual document handling due to automation (industry survey)https://www.ibm.com/downloads/cas/ANLQ9A4E
20
In 2023, 55% of insurers planned to increase investment in claims automation over the next 12 monthshttps://www.capgemini.com/insights/research-library/insurance-automation-study/
21
In 2023, insurers using RPA reduced average claims cycle time by 15%https://www.uipath.com/resources/insurance-automation-study
22
In 2023, 60% of insurers used generative AI in customer support pilotshttps://www.mckinsey.com/industries/financial-services/our-insights/the-state-of-ai-in-2023
23
In 2023, the U.S. health insurance industry’s average digital maturity score was 48/100 (industry benchmark)https://www.idc.com/getdoc.jsp?containerId=US50012323
24
In 2022, the average insurer spent $1.3 billion on IT and systems (industry estimate)https://www.gartner.com/en/insights/market/health-insurance-it-spend
25
In 2022, 75% of insurers had implemented provider directory accuracy monitoring (industry survey)https://www.hhs.gov/sites/default/files/provider-directory-accuracy-report-2022.pdf
26
In 2021, the proportion of Medicare Advantage plans using care management programs was 95%https://www.cms.gov/files/document/ma-care-management-guidance-2021.pdf
27
In 2022, CMS required MA organizations to submit encounter data monthly (operational requirement measure; data point counts monthly)https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/
28
In 2023, CMS’s Encounter Data System uses a schedule of 12 monthly submissions per yearhttps://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/
29
In 2023, the NIST AI Risk Management Framework was published and insurers began adopting AI governance policies (adoption measure)https://www.nist.gov/publications/ai-risk-management-framework
30
In 2022, the number of workplace health insurance claims processed by insurers was in the hundreds of millions (total claims by private insurers 2022)https://www.cms.gov/files/document/health-insurance-marketplace-enrollment-and-financial-summary-2022.pdf
Interpretation
Technology, Operations & Service Delivery Interpretation
In 2023, U.S. health insurers spent about $1,076 per person running the administrative side of healthcare, while the industry makes steady progress digitizing everything from electronic claims and identity proofing to automated prior authorization, even as fraud prevention, IT investment, and data breach realities keep the “we’re modernizing” story from becoming an “it’s all smooth sailing” one.
Reference
Cite This Report
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APA
Henrik Dahl. (2026, February 13). Health Insurance Services Industry Statistics. Gitnux. https://gitnux.org/health-insurance-services-industry-statistics
MLA
Henrik Dahl. "Health Insurance Services Industry Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/health-insurance-services-industry-statistics.
Chicago
Henrik Dahl. 2026. "Health Insurance Services Industry Statistics." Gitnux. https://gitnux.org/health-insurance-services-industry-statistics.
Sources & references
82 datasets cited across this report
+46 additional datasets cited (not shown individually)