Best’s News & Research Service - December 31, 2025 10:06 AM (EST)
US Health Carriers Dominate AM Best Ranking of World's Top Insurers by NPW
OLDWICK, N.J. //BestWire// - U.S. health insurers again dominated AM Best's annual ranking of the world's largest insurer in terms of net premiums written while a diverse mix of international companies populated the ranking in terms of total non-banking assets.
Ranked by 2024 NPW, five of the top 10 and four of the top five insurers are U.S. health insurers.
In the NPW ranking, UnitedHealth Group Inc. remained at No. 1 as its NPW rose 6.2% to $308.81 billion.
Centene Corp., Elevance Health Inc. and Kaiser Foundation Health Plan Inc. retained their second, third and fourth position respectively as the same top 10 insurers remained, with slight variations in rank below No. 4.
At No. 5, U.S. property/casualty insurer State Farm Group saw its NPW achieve the highest percentage increase among the top 10, rising 16.4% to $114.47 billion.
Among the top 10 in terms of NPW, the only non-U.S. domiciled insurers were seventh-ranked China Life Insurance (Group) Co., eighth-ranked Allianz SE of Germany and 10th-ranked Axa SA of France.
Progressive Corp., which ranked No. 12, showed the highest percentage increase among the top 25 as NPW rose 20.9%.
Nippon Life Insurance Co., at No. 24, has the biggest percentage decline as NPW fell 10.9%. Another Japanese life insurer, 21st-ranked Dai-ichi Life Holdings Inc., saw NPW fall 9.7%.
There were several factors impacting premium growth in 2024, said Sally Rosen, senior director, AM Best.
AM Best has seen and expects 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.
Due to Medicaid redeterminations and the resulting loss of Medicaid coverage, individual Affordable Care Act segment has seen enrollment growth in 2024 as some people shifted from Medicaid to an individual ACA policy, she said.
Additionally, the federal government increased subsidies in 2021 for ACA individual exchange plans, which remains in effect through 2025. As a result, more individuals have kept coverage as well as those opting to enroll in an ACA plan.
In terms of an impact of premium rate increases, Rosen said while Medicaid membership declined in 2024 due to the impact of redeterminations, health insurers continued to work with states on premium rate increases.
There was a mismatch between the acuity of the membership and the premium rates as historical data from the past 12 to 24 months are used for pricing, which would have included experience for members who were disenrolled as part of the redetermination process, Rosen said.
Ranked by 2024 net non-banking assets, the top 25 is a diverse mix of companies, with U.S., European and Asian companies represented throughout the list.
Ranked by total non-banking assets, Berkshire Hathaway Inc. was the top insurer with 2024 assets of $1.15 trillion, up 7.8% from the previous year.
Berkshire Hathaway grabbed the top spot from Allianz SE, which fell to No. 2 with assets of $1.09 trillion up 6.2%.
The rest of the top five retained their previous positions. Third-ranked China Life Insurance (Group) Co. saw its assets rise 10.5% to $1.02 trillion and Ping An (Group) Company of China Ltd. rose 19.9% to $984.67 billion. At No. 5, Prudential Financial Inc.'s total assets rose 2.0% to $735.59 billion.
Athene Holding Ltd., ranked No. 24, was the top percentage gainer as non-banking assets rose 20.9%.
At No. 21, Japan's National Mutual Insurance Federation of Agricultural Cooperatives declined at the highest rate, down 2.6%. Japan Post Insurance Co., at No. 18, fell 2.1%.
Some of China’s largest insurance groups, including China Life and Ping An Group, continued to report growth in their non-banking assets denominated in the Chinese yuan, securing their well-positioned global ranking, said Christie Lee, senior director, AM Best.
For China Life, the expansion in the balance sheet was primarily driven by the enlarged investment in debt instruments, Lee said. The company maintained an overall stable investment allocation strategy with a vision of engaging in medium- to long-term investment.
For Ping An, the total asset growth rate is among the highest of the top 25 insurers, with non-banking assets growing by nearly 20%, she said. The increase was mainly driven by growth in debt financial assets, reflecting its rapid expansion in the life and health insurance segment.
Compared to the growth of assets, the top-line growth for those largest Chinese insurance groups was more moderate, ranging from mid to high single-digit as measured by the local currency, Lee said. The growth was partially offset by the Chinese yuan depreciated against the U.S. dollar by 3.2% in 2024.
In Japan, Nippon Life's total assets saw a slight decline of 1.3% in local currency terms but given the yen/U.S. dollar exchange rate remained broadly stable over the past 12 months, its total assets in U.S. dollars showed little change, Lee said. Consequently, its global ranking remained largely unchanged, slipping slightly from 10th to 11th place.
Dai-ichi Life Holdings Inc.'s total assets increased by 3% in local currency, and with the yen/dollar exchange rate remaining broadly stable, its total assets in U.S. dollars also showed modest improvement. As a result, its global ranking rose slightly, moving from 17th to 14th place, Lee said.
For Japan Post Insurance Co. Ltd., total assets declined by 2% in local currency, and with the yen/dollar exchange rate remaining broadly stable. Its global ranking remained broadly unchanged, improving marginally from 19th to 18th place, she said.
(By David Pilla, news editor, BestWire: David.Pilla@ambest.com)