United States Health Insurance Market Projected to Reach USD 2.13 Trillion by 2030 Amidst Digital Transformation and Policy Reforms

Mordor Intelligence has published a new report on the United States Health Insurance Market, offering a comprehensive analysis of trends, growth drivers, and future projections.

The United States health insurance market is undergoing significant expansion, driven by digital transformation, policy reforms, and evolving consumer preferences. Valued at approximately USD 1.59 trillion in 2025, the market is projected to reach USD 2.13 trillion by 2030, reflecting a compound annual growth rate (CAGR) of 6% during the forecast period. This growth is influenced by factors such as the increasing adoption of High Deductible Health Plans (HDHPs), the rapid expansion of Pharmacy Benefit Management (PBM) services, and a shift towards off-exchange health insurance plans.

Report Overview: https://www.mordorintelligence.com/industry-reports/united-states-health-and-medical-insurance-market

Key Trends

Dominance of High Deductible Health Plans (HDHPs)

In 2024, HDHPs commanded approximately 65% of the U.S. health insurance market share. Employers are increasingly adopting HDHPs as a cost-effective insurance option for their workforce. For 2024, the Internal Revenue Service (IRS) defines an HDHP as any plan with a deductible of at least USD 1,400 for individuals or USD 2,800 for families, with total yearly out-of-pocket expenses capped at USD 7,050 for individuals and USD 14,100 for families. This trend reflects a growing emphasis on consumer-driven healthcare, where individuals are encouraged to make cost-conscious medical decisions.

Rapid Growth of Pharmacy Benefit Management (PBM) Services

The PBM segment is experiencing accelerated growth, with an expected rate of approximately 9% from 2024 to 2029. PBMs play a crucial role in negotiating drug prices and managing prescription drug insurance benefits for health insurers, Medicare Part D plans, and major employers. Their influence in controlling medication costs and optimizing pharmaceutical utilization has become increasingly significant, especially amidst rising prescription drug expenditures.

Preference for Off-Exchange Health Insurance Plans

In 2024, the off-exchange/marketplace segment dominated the market, accounting for approximately 74% of the total market share. This segment includes both Affordable Care Act (ACA)-compliant plans sold outside of the exchange and non-compliant plans operating in separate risk pools. The primary distinction between on-exchange and off-exchange ACA-compliant plans lies in the availability of subsidies, which are exclusively offered through the exchange platform. Off-exchange plans typically provide more flexibility in plan design and often feature a higher proportion of preferred-provider organization (PPO) or point-of-service (POS) plans, appealing to consumers who do not qualify for subsidies and prefer diverse healthcare provider options.

Market Segmentation

The U.S. health insurance market is segmented based on procurement type, products and services, and place of purchase:

By Procurement Type:

Directly Purchased: Individuals acquiring health insurance plans independently, often through private insurers or brokers.

Employer-Based: Plans provided by employers as part of employee benefits packages, representing a significant portion of insured individuals.

By Products and Services:

Pharmacy Benefit Management (PBM): Services that manage prescription drug benefits on behalf of health insurers, focusing on cost control and formulary management.

High Deductible Health Plans (HDHPs): Insurance plans with higher deductibles and lower premiums, encouraging consumers to make informed healthcare decisions.

Fee-For-Service Plans: Traditional insurance models where providers are paid for each service rendered, offering flexibility in choosing healthcare providers.

Managed Care Plans: Plans that contract with healthcare providers and medical facilities to provide care for members at reduced costs, emphasizing coordinated care.

By Place of Purchase:

On Exchange: Plans purchased through government-run marketplaces established under the ACA, often eligible for subsidies.

Off Exchange: Plans purchased outside of government marketplaces, offering a wider array of options but typically without subsidy eligibility.

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Key Players

The U.S. health insurance landscape is dominated by several major players, including:

UnitedHealth Group: A leading provider offering a diverse range of health benefit plans and services, known for its extensive network and innovative healthcare solutions.

Anthem: One of the largest health benefits companies, providing a variety of medical and specialty products, with a strong presence across multiple states.

Humana Group: Focuses on delivering personalized healthcare experiences, offering plans that cater to individuals, families, and seniors.

Kaiser Permanente: An integrated managed care consortium, recognized for its emphasis on preventive care and comprehensive health services.

Centene Corporation: Specializes in government-sponsored healthcare programs, including Medicaid and Medicare, serving under-insured and uninsured individuals.

These industry leaders are increasingly focused on digital transformation through investments in telehealth platforms, artificial intelligence, and data analytics capabilities to enhance operational efficiency and customer experience. Companies are expanding their service portfolios through strategic acquisitions and partnerships, particularly in specialized areas like Medicare Advantage plans and managed care services. The industry is witnessing accelerated adoption of insurtech solutions, with companies developing mobile applications, implementing chatbots, and leveraging IoT devices for better risk assessment and personalized coverage options. Market leaders are also emphasizing value-based care models and preventive health programs while strengthening their provider networks through strategic collaborations with healthcare systems and clinics.

Conclusion

The United States health insurance market is poised for substantial growth, driven by digital innovation, policy reforms, and changing consumer dynamics. As the industry navigates challenges such as rising healthcare costs and regulatory shifts, insurers are adopting advanced technologies and diversifying their offerings to meet the evolving needs of consumers. The emphasis on cost-effective plans like HDHPs, the expansion of PBM services, and the preference for flexible off-exchange plans are shaping the future landscape of health insurance in the country. Stakeholders are encouraged to stay abreast of these trends to capitalize on emerging opportunities and address the complexities of the evolving healthcare environment.

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