Health Insurance Competition and Market Share in Pennsylvania

November 14, 2024

Insurance companies provided medical coverage for nearly thirteen million people in Pennsylvania, as of June 30, 2024, based on enrollment reported in Mark Farrah Associates’ (MFA’s) County Health Coverage^TM. As a mix of national, regional, and local insurance carriers do business in its 67 counties, Pennsylvania is an ideal state to examine. The focus of this brief is Pennsylvania’s top three counties based on total health enrollment – Philadelphia, Allegheny, and Montgomery Counties.

Competition and Market Share

In Pennsylvania, four insurance carriers provide health insurance to 75% of the state’s entire insured population. Highmark and Independence Blue Cross (IBX), both multi-state regional carriers, cover nearly 53% of the state’s health insurance market, combined. CVS, a large national insurance carrier, and University of Pittsburgh Medical Center (UPMC), a local insurer, cover 12% and 10% of enrollment, respectively. The remaining 25% of the state’s insured receive some form of medical coverage from one of thirty-seven other insurers.

• Philadelphia County, the most populous county in Pennsylvania, is largely insured by IBX and CVS, with over 74% of the insured enrollment split between the two. IBX covers 55% of the county’s insured, nearly triple that of CVS. Highmark and UPMC, while major players in the state, have very little presence in this county.
• Allegheny County, home to the city of Pittsburgh, is insured almost exclusively by Highmark and UPMC, with nearly 85% of the county’s insured population covered by just these two carriers. Combined, CVS and IBX cover about 5%, or roughly 85,000 people, in Allegheny County, while 10% of the county’s insured are covered by other providers.
• Montgomery County, like Philadelphia, is largely comprised of IBX and CVS, which represent a combined total of nearly 82% of the county’s insured. IBX’s penetration in Montgomery is stronger, however, as it covers more than four times as many people as CVS in the county. The reliance on smaller insurers is more prevalent here than in Allegheny, with 17%, or nearly 159,000 people seeking coverage from other insurers.
• For the nearly thirteen million Pennsylvanians across the state with health insurance, including those discussed above, fourteen insurers provided private enrollment, seven offered coverage through Medicaid programs, and thirty-eight presented Medicare Advantage plans. Seven carriers, a combination of national and regional, offered plans across all three enrollment types.

About County Health Coverage^TM

County Health Coverage^TM provides reliable estimates of health insurance enrollment and market share at the state, county, and Metropolitan Statistical Area (MSA) levels. Product features include company market share by county, company, and state for the Individual, Private Group Risk, Private Administrative Services Only (ASO), Managed Medicaid, Medicare Advantage, and stand-alone Prescription Drug Plan (PDP) segments. Breakdowns by product type (HMO, PPO, etc.) are also presented, as well as population demographics and interactive, visual mapping tools. To learn more, visit the product page under the Our Products section of our website - County Health Coverage^TM.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health ^PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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