Best’s News & Research Service - January 03, 2025 10:00 AM (EST)
Health Underwriters Dominate in Best's Ranking of World's Largest Insurers
OLDWICK, N.J. //BestWire// - UnitedHealth Group retained its top position in AM Best’s annual ranking of the world's top 25 insurers by 2023 net premiums written.
The rest of the top four insurers, Centene Corp., Elevance Health Inc. and Kaiser Foundation Group of Health Plans, all health insurers, kept their place in the ranking from the previous year.
UnitedHealth posted $290.83 billion in 2023 NPW, up 13.1% from the previous year. Second-ranked Centene Corp.'s NPW rose 9.8% to $149.54 billion and third-ranked Elevance Health Inc.'s NPW rose 7.2% to $142.85 billion. Eight of the top 10 insurers saw their NPW rise last year. China Life Insurance Group gained one spot in the rankings to fifth after NPW increased 4.7% to $107.86 billion.
As it rose to No. 7 from No. 10, State Farm Group's NPW increased 19.1%. Humana Inc., in rising to No. 6 from No. 9, saw its NPW increase 15.5%. NPW rose 11.7% for Berkshire Hathaway Inc. as the company rose to No. 9 from No. 13.
There were several factors impacting premium growth among health insurers in 2023, said Sally Rosen, senior director, AM Best.
"We have and expect to see continued growth in Medicare Advantage driven by the aging population; more of which are selecting a Medicare Advantage plan versus traditional fee-for-service Medicare," Rosen said. "Additionally, Medicare Advantage’s average premium per member is higher than that of commercial products."
The federal government increased subsidies in 2021 for individual exchange plans (under the Affordable Care Act), which remains in effect through 2025, Rosen said. As a result, more individuals have kept coverage as well as those opting to enroll in an ACA plan.
"Furthermore, with Medicaid redeterminations and the resulting loss of Medicaid coverage, individual ACA segment has seen enrollment growth in 2023 as some people shifted from Medicaid to an individual ACA policy," she said.
Looking at the impact of premium rate increases, UnitedHealth Group experienced mid-single-digit Medicare Advantage enrollment growth, and for Humana that growth was in the mid-teens in 2023, Rosen said.
Medicaid disenrollment due to redeterminations (and the end of the public health emergency) accelerated in the third and fourth quarter of 2023, she said. While membership was down at year-end 2023 versus year-end 2022, membership and premiums in Medicaid managed care were elevated for most health insurers during the first half of the year.
The two top 10 insurers that saw their NPW drop last year were Axa SA, which fell to No. 10 from No. 7 as its NPW fell 19.5%, and Allianz SE, which remained in eighth place while its NPW fell 5.1%.
The biggest percentage drops in NPW were from Italy’s Assicurazioni Generali, which fell 39.6%, and China's Ping An Insurance (Group) Company of China Ltd., down, 30.1%. Generali fell to No. 18 from No. 12 in the ranking. Ping An fell to No. 11 from No. 5.
Top gainers in terms of NPW percentage were Nippon Life Insurance Co., up 21.7%; Progressive Corp., up 20.5%; Chubb Ltd., up 13.5%; and Dai-ichi Life Holdings Inc., up 13.1%.
Ranked by net non-banking assets, Allianz SE remained on top as its assets rose 5.1% to $1.085 trillion.
The top 10 insurers remained the same with small changes in rank.
Second-ranked Berkshire Hathaway Inc. moved up from No. 3 as its net non-banking assets rose 12.8% to $1.07 trillion. China Life Insurance (Group) Co. moved to third from fourth place with assets of $957.82 billion, up 10.5%.
Some of the largest Chinese insurance groups, including China Life and Ping An Group, continued to report growth in their non-banking assets denominated in the Chinese yuan, despite the currency depreciating against the U.S. dollar by 2.4% in 2023, said Christie Lee, senior director, AM Best.
For China Life, expansion in the balance sheet was driven by the enlarged investment portfolio, in particular in bonds, Lee said. For Ping An, the increase was mainly driven by growth in financial assets, in particular in the life and health segment, namely Ping An Life and Ping An Health.
For Nippon Life, despite an 11.4% increase in assets in local currency, the majority of assets are denominated in Japanese yen, which depreciated around 12% against the U.S. dollar, leading to a drop in global ranking, Lee said.
Japan Post assets saw a slight decline of 2.9% in local currency, Lee said. Similar to Nippon Life, a significant portion of assets are denominated in yen. The depreciation of yen by about 12% against the U.S. dollar contributed to the decline in the global ranking.
Other double-digit gainers by net non-banking assets were Life Insurance Corp. of India, which increased 16.2% and rose to No. 11 from No. 12.
Nippon Life insurance Co.'s assets increased 11.4% but its ranked position fell to No. 10 from No. 8. Lincoln National Corp.'s assets also rose 11.4% as the company made the list, ranked at No. 21.
Besides japan Post, TIAA Group was the only other insurer in the ranking to report lower net non-banking assets in 2023 with a drop of 0.4% but its ranking rose to No. 22 from No. 25.