2025: Big Insurance’s $1.7 Trillion Year

America’s big seven health insurers raked in $54 billion in profits in 2025 — as they covered fewer people, raised prices and steered patients into their own subsidiaries and taxpayer-funded programs.

Key Takeaways

In 2025, the seven biggest health insurance conglomerates:

• Collected almost $1.7 trillion in total revenues, $175 billion more than in 2024

• Made more than $54 billion in profits

• Covered 10 million fewer people than in 2024

• Ramped up their self-dealing by steering more of their health plan enrollees to physician practices, clinics, pharmacy operations and other clinical businesses they now own

• Took record amounts of money from state and federal governments. As a result:

  • UnitedHealthcare now gets more than 77% of its revenues from government programs even though it covers almost twice as many people in its commercial plans. That said, all of UnitedHealthcare’s enrollment growth since 2015 has been in Medicare Advantage and Medicaid. It covered 80,000 fewer commercial health plan enrollees in 2025 than it did in 2015. In addition:

  • UnitedHealth Group now classifies approximately 27% of its revenues as “intercompany eliminations.” That percentage has increased every year as UnitedHealthcare has steered more and more of its health plan enrollees (and their premiums) to health care delivery operations that Optum, its sister division, owns.

The seven largest for-profit health insurance conglomerates took in nearly $1.7 trillion from their customers in 2025 – $175 billion more than in 2024 – and they booked more than $54 billion in profits (earnings from operations).

The companies — UnitedHealth, CVS/Aetna, Cigna, Elevance/Anthem, Humana, Centene and Molina — achieved that revenue growth in part by charging their private-paying customers (and the government) much more in premiums and fees in 2025 than in 2024. The cost of an employer-sponsored family policy increased an average of 6% last year and is expected to spike even higher this year.

As a result, while the Big 7 were making big profits (although not big enough to satisfy the companies’ shareholders, and not as much as they made in 2024), the average cost of an employer-sponsored plan last year reached $26,993 (the price of a brand new Subaru), up from $25,572 in 2024 – and 54% more than the $17,545 average cost in 2015.

Deductibles and other cost-sharing requirements imposed by insurers have also increased by more than 50% since 2015.

Health insurance has become so expensive in the United States that only the very richest Americans can afford health insurance — and the care it theoretically gives us access to — without an employer, union or government heavily subsidizing it.

The big insurers also achieved their revenue gains by charging our federal and state governments (us, as taxpayers) considerably more to provide coverage for the nearly 60 million Americans enrolled in their private Medicare Advantage plans and in the Medicaid programs they administer in many states.

Even with all that, the company’s shareholders — primarily huge institutional investors like Blackrock, Morgan Stanley and Vanguard — were greatly disappointed with insurers’ 2025 results. They’ve dumped millions of their shares since the first of the year, sending the companies’ stock prices to 52-week lows in many cases.

Shareholders were upset primarily because all but one of the for-profit giants reported significant increases in paid medical claims last year, which caused an obscure mathematical calculation called the medical loss ratio (MLR) to jump a few “basis points” higher. The MLR is the percentage of revenue insurers spend paying claims. (Insurers consider it a loss when they pay a claim.) Only Aetna, which is part of CVS Health, reported a decline in its MLR last year.

For-profit insurers are under constant pressure from Wall Street to not only increase premiums every year but to spend less and less of their premium revenue paying claims. It explains why the value of a health insurance policy shrinks in one or more ways every year even as we pay higher premiums. (The insurance industry’s term for this ongoing and uniquely American phenomenon is “benefit buydown.”)

Evidence of how Wall Street views changes in an insurer’s MLR is the fact that CVS — whose Aetna health plans reported an MLR decline last year of 130 basis points (1.3%) — is the only one of the seven whose share price is higher today than it was two years ago.

Most of the companies saw their MLRs decrease during the pandemic, 2020 in particular – even dipping below the legal minimum limit of 80% at Cigna and UnitedHealthcare – as millions of Americans avoided going to the doctor and to hospitals for elective procedures. The pandemic years were especially profitable for most of the companies. Their MLRs have increased since the end of the pandemic as more people have sought care they had postponed.

[Note that as a company’s MLR increases, another metric Wall Street pays close attention to — earnings per share (EPS) — typically declines. Investors and insurers’ C-suite executives, who are paid primarily in stock, see the value of their holdings and net worth decline when that happens. The companies have several levers they can pull to return to a level of profitability shareholders expect. See a partial list below.]

Sharp drops in share prices

All of the insurers except CVS/Aetna, which achieved its MLR decline last year by dumping hundreds of thousands of seniors and people with disabilities from its Medicare Advantage rolls, have seen steep declines in their share prices since early 2024. To meet Wall Street’s profit expectations this year, the companies’ executives told shareholders during their recent quarterly earnings calls that they are taking a range of actions to push their MLRs down and their profit margins and earnings per share up, including:

• Increasing premiums even higher than last year

• Removing an untold number of doctors and other providers they don’t own or control from their provider networks

• Making their health plan enrollees pay more out of their own pockets before their coverage kicks in

• Reducing or eliminating some benefits

• Mandating that Medicare Advantage enrollees get referrals from a primary care physician to see a specialist (even though many don’t have a PCP)

• Reducing payments to doctors, hospitals and other providers

• Intensifying “medical management” practices (including prior authorization)

• Purging millions more health plan enrollees from their rolls

Those actions, by design, will make it harder for millions of Americans to get the care and medications their doctors say they need. And the ranks of the uninsured and underinsured will grow.

Outlook for 2026

More revenue and enrollment shrinkage, more hassle and expense for consumers, patients and health care providers

Many of the companies also told their shareholders and Wall Street financial analysts during their earnings calls in late January and early February to expect a decline in both their revenues and health plan enrollment in 2026, which is unprecedented for most of them. These are companies that not so long ago were Wall Street darlings because of their reliably consistent and substantial revenue growth, although revenue (and earnings) growth has slowed in recent quarters, as you can see in the accompanying charts.

Total revenues for the seven companies increased almost 12% from 2024 to 2025 – and have increased 300% since 2015, largely because of mergers and acquisitions rather than growth in health plan enrollment (except for big enrollment gains in the taxpayer-supported Medicare Advantage and Medicaid programs, where most of the companies have focused their attention in recent years).

In fact, UnitedHealthcare, Humana and Aetna, the three two biggest Medicare Advantage insurers, have fewer enrollees in their private individual and employer-sponsored plans now than they did in 2015, even as the U.S. population has increased by 18 million.

As a consequence of its shrinking commercial book of business and emphasis on public programs, UnitedHealthcare now gets 77% of its revenues from the taxpayer-supported Medicare Advantage and Medicaid programs, even though almost twice as many people are enrolled in its commercial plans. The percentage at Humana is even higher. It is also higher at Centene and Molina, which, except for people in their Obamacare plans, have relatively few commercial health plan enrollees.

UnitedHealthcare had 80,000 fewer commercial enrollees at the end of 2025 than in 2015, Aetna had 600,000 fewer and Humana, which sold its commercial health insurance business to focus on Medicare Advantage, had 1.3 million fewer.

(In 2025, Humana had 4.6 million enrollees in TRICARE, the government-paid health benefits program for uniformed service members, retirees and their family members. In the chart, we include those enrollees under commercial enrollees.)

Putting all of its eggs in the Medicare Advantage basket so far hasn’t worked very well for Humana, where I used to work. Its insurance division reported a loss of almost a billion dollars in the fourth quarter of 2025. Centene, which also gets the vast majority of its revenue from taxpayer-supported programs, recorded an eye-popping loss of $7.6 billion in 2025.

Cigna, where I also worked, went in the opposite direction and got completely out of the Medicare Advantage business last year when it sold its MA plans to Health Care Services Corporation for $3.3 billion. Since then, Cigna has fared much better financially – and done much better on Wall Street – than its competitors.

Cigna’s size and fortunes changed dramatically when it bought the large pharmacy benefit manager Express Scripts a few years ago. The vast majority of Cigna’s revenues and profits now come from the division that encompasses Express Scripts and the company’s other pharmacy operations, not from its health insurance division. The same is true at CVS Health. Its PBM, CVS Caremark, now contributes more to the parent company’s revenues and profits than its more than 9,000 retail stories and all of Aetna’s health plans. (Cigna’s Express Scripts, CVS Caremark and UnitedHealth’s PBM, Optum Rx, have grown so big they now control 80% of the pharmacy benefit market.)

The numbers tell a story that these companies and Wall Street would prefer folks not notice. In 2025, there were fewer people covered, higher costs and more taxpayer dependence. When insurers call paying claims a “loss,” it’s a reminder that the system is functioning exactly as designed — just not for patients. Tomorrow I’ll dive even deeper into these numbers.