Private Health Insurance: Market Concentration in 2024 Was Generally Higher Than in 2011

What GAO Found Since 2014, GAO has reported that enrollment in private health insurance plans has been concentrated, meaning a small number of issuers, such as health insurers, enrolled most of the people in a given market. Specifically, GAO considers a market concentrated in a state if three or fewer issuers hold at least 80 percent of the market share of enrollment. For this report, GAO examined the individual (coverage primarily sold to individuals who lack access to group coverage), small-group (coverage offered by small employers), and large-group (coverage offered by large employers) health insurance markets from 2011 through 2024 across states. GAO found that the number of states with concentrated markets generally increased, with recent decreases in the individual market (see figure). Number of States, Including the District of Columbia, Where the Three Largest Issuers Had at Least 80 Percent of Enrollment, 2011 Through 2024 Note: The most recent years in GAO’s series on market concentration, 2023 and 2024, are highlighted in this figure. GAO also examined concentration across the individual insurance exchanges, which are part of the overall individual market. Individual ex

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