Clean bill: As demand from the aging US population increases, industry revenue will rise

The Health and Medical Insurance industry, which is made up of carriers of private, group and public health, medical and dental insurance, was characterized by slow growth over the past five years to 2018 as a result of reduced employer coverage and continued consumer deleveraging. However, consistent increases in healthcare expenditure and medical cost inflation, as well as a sharp decline in the uninsured rate, have driven industry growth in recent years. Over the five years to 2023, revenue is forecast to rise. Key sources of growth include medical cost inflation and increased demand from the aging US population. As the baby boomer generation ages, more people will need medical coverage and the retirement of baby boomers will particularly increase Medicare expenditure...purchase to read more.

Industry Statistics & Market Size
Annual Growth 13-18
Forecast Growth 18-23

Industry Threats & Opportunities

  • Healthcare reforms have been introduced that aim to increase access to healthcare
  • Many companies have reduced employee benefits to offset rising healthcare costs
  • Medical cost inflation and increased demand for medical insurance will dictate performanc
  • Industry Report - Industry Locations Chapter

    The geographical distribution of health insurance establishments has changed relatively little over the past decade because the distribution of health insurance is conducted on a state-by-state basis due to industry regulations. State insurance commissioners largely regulate the Health and Medical Insurance industry, so health insurers must meet various state requirements to get an operating license. The state-based structure also has a dramatic effect on health insurance costs and coverage rates. States have the option to design, implement and run their own health insurance exchanges (within federal guidelines). In ...purchase to read more.

    Additional Insights for the Health & Medical Insurance Industry

    IBISWorld identifies 250 Key Success Factors for a business.The most important for the Health & Medical Insurance Industry are

  • Having an extensive distribution/collection network
  • Having a good reputation
  • Ability to pass on cost increases
  • IBISWorld analysts also discuss how external factors such as Total health expenditure and Number of employees in the Health & Medical Insurance industry impact industry performance..

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    What's in this report

    What is the Health & Medical Insurance Industry?

    This industry underwrites (i.e. assumes the risks of and assigns premiums for) health and medical insurance policies. Insurance is the transfer of the risk of a loss in exchange for payment. Operators also provide administrative services for self-funded insurance plans. Under this structure, the industry operator is a third-party administrator and is not responsible for health benefit payments. This industry does not include direct government health insurance.

    Industry Products
  • Pharmacy benefit management (PBM)
  • Preferred provider organization (PPO) plans
  • High-deductible health plans (HDHPs)
  • Health maintenance organization (HMO) plans
  • Point-of-service (POS) plans
  • Fee-for-service (FFS) plans
  • Managed care plans
  • Industry Activities
  • Underwriting health and medical insurance policies
  • Underwriting dental policies
  • Providing pharmacy benefit management services
  • Managing care between the health provider and individual recipient
  • Administering of self-funded insurance plans
  • Investing health insurance premiums
  • Table of Contents

    Industry Definition
    Main Activities
    Similar Industries
    Additional Resources
    Industry Statistics Snapshot
    Industry Structure
    Executive Summary
    Executive Summary
    Key External Drivers
  • Total health expenditure
  • Number of employees
  • Median age of population
  • Number of physician visits
  • Per capita disposable income

  • Current Performance
  • Healthcare costs drive revenue
  • Demographic trends
  • Reform spurs acquisitions
  • Chart: Revenue Growth

  • Industry Outlook
  • Healthcare costs drive revenue
  • Demographic trends
  • Table: Health & Medical Insurance Industry Revenue Outlook

  • Industry Life Cycle
  • Life cycle reasons
  • Chart: Benchmarking - Health & Medical Insurance Industry Lifecycle vs The Economy

  • Supply Chains
    Key Buying Industries
  • Consumers

  • Key Selling Industries
  • Custody, Asset & Securities Services
  • Portfolio Management

  • Products & Services
  • Preferred provider organization (PPO) plans
  • Pharmacy benefit management (PBM)
  • High-deductible health plans (HDHPs)
  • Managed care plans
  • Health maintenance organization (HMO) plans
  • Point-of-service (POS) plans
  • Fee-for-service (FFS) plans
  • Chart: Health & Medical Insurance Industry Products and Services Segmentation

  • Demand Determinants
    Major Markets
  • Consumers with employer-sponsored health insurance
  • Consumers with Medicaid
  • Consumers with Medicare
  • Consumers with direct-purchased health insurance
  • Consumers with other insurance plans
  • Chart: Major Market Segmentation for the Health & Medical Insurance Industry

  • International Trade
    Business Locations
    Chart: Business Locations by State
    Market Share Concentration
    Key Success Factors
    Cost Structure Benchmarks
    ProfitHealthcare benefit expensesWagesOperating and other expenses
  • Chart: Cost Structure Benchmarking – Sector vs Health & Medical Insurance

  • Basis of Competition
    Barriers to Entry
  • Table: Barrier to Entry Checklist for the Health & Medical Insurance Industry

  • Industry Globalization
    UnitedHealth Group Inc., Anthem Inc., Aetna Inc., Humana Inc.,
  • Table: UnitedHealth Group Inc. - financial performance
  • Table: Anthem Inc. - financial performance
  • Table: Aetna Inc. - financial performance
  • Table: Humana Inc. - financial performance

  • Capital Intensity
  • Chart: Level of Capital Intensity for the Health & Medical Insurance Industry
  • Chart: Tools of the Trade: Growth Strategies for Success

  • Technology & Systems
    Revenue Volatility
  • Chart: Volatility vs Industry Growth

  • Regulation & Policy
    Industry Assistance
    Table: Industry Data for the Health & Medical Insurance Industry
  • Industry Revenue (2009-2023)
  • Industry Gross Product (2009-2023)
  • Establishments (2009-2023)
  • Businesses (2009-2023)
  • Employment (2009-2023)
  • Wages (2009-2023)
  • Total Health Expenditure (2009-2023)

  • Table: Annual Percentage Change for Key Industry Data
    Table: Key Ratios for Industry Key Data
    Table: Industry Financial Ratios
    Fully Funded Insurance
  • A type of coverage where a health insurer is financially responsible for paying all incurred benefits and administration costs of healthcare services. In return, the company receives a premium.
  • Health Maintenance Organization (Hmo)
  • A healthcare organization composed of physicians, hospitals or other providers that offer healthcare services at a reduced fee. Payment is made in advance, before services are rendered.
  • High-Deductible Health Plan
  • A health insurance plan that has a high-minimum deductible that does not cover the initial costs or all of the costs of medical expenses.
  • Indemnity Plan
  • A health plan with no preferred physician network that reimburses for medical expenses regardless of who provides the service. However, in some cases the reimbursement amount may be limited.
  • Managed Care
  • A general term that refers to the organization of doctors, hospitals and other providers into groups in order to enhance the quality and cost-effectiveness of healthcare.
  • Medical Loss Ratio
  • The ratio of premiums used to pay medical claims and improve the quality of care.
  • Point-Of-Service (Pos)
  • An HMO/PPO hybrid or "open-ended HMO" where members can choose which option (HMO or PPO) they will use each time they seek healthcare.
  • Preferred Provider Organization (Ppo)
  • A healthcare organization composed of physicians, hospitals or other providers that offer healthcare services at a reduced fee. Payment is made when services are rendered.
  • Self-Funded Insurance
  • A type of coverage where an employer or organization assumes complete responsibility for healthcare benefit payments instead of a health insurer.
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    Why buy this report?

    IBISWorld’s Health & Medical Insurance Industry Research Report offers insight into the market at the national level. Our analysis highlights macro trends in the overall sector and the micro trends faced by companies that do business in the Health & Medical Insurance industry. Our five-year outlook forecasts explain how the market is set to change and the product segments that will drive growth.

    IBISWorld industry market research reports enable you to:
    • Find out about key industry trends
    • Identify threats and opportunities
    • Inform your decisions for marketing, strategy and planning
    • Quickly build competitive intelligence
    This report on Health & Medical Insurance:
    • Provides Market Size information to assist with planning and strategic decisions.
    • Includes the necessary information to perform SWOT, PEST and STEER analysis.
    • Helps you understand market dynamics to give you a deeper understanding of industry competition and the supply chain.
    • Analyses key performance and operational metrics so that you can benchmark against your own business, that of your customers’ businesses, or your competitors’ businesses.
    The Health & Medical Insurance market research report includes:
    • Historical data and analysis for the key drivers of this industry
    • A five-year forecast of the market and noted trends
    • Detailed research and segmentation for the main products and markets
    • An assessment of the competitive landscape and market shares for major companies
    • And of course, much more

    IBISWorld reports on thousands of industries around the world. Our clients rely on our information and data to stay up-to-date on industry trends across all industries. With this IBISWorld Industry Research Report on Health & Medical Insurance, you can expect thoroughly researched, reliable and current information that will help you to make faster, better business decisions.

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