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AMA Report: Health Insurance Giants Tighten Grip on U.S. Markets
At the end of 2025, the American Medical Association (AMA) released, Competition in Health Insurance: A Comprehensive Study of U.S. Markets, an updated analysis showing that a small number of health insurance companies continue to dominate both commercial and Medicare Advantage markets across the United States. Using 2024 data from hundreds of metropolitan areas, all 50 states, and Washington, D.C., the report examines how much control the largest insurers hold and whether consumers are benefiting from meaningful competition. By applying updated federal merger guidelines, the AMA’s report found that most markets meet the definition of being highly concentrated, a condition that often leads to higher prices and fewer choices for patients.
According to the AMA, consolidation has intensified over the past decade, particularly in the commercial insurance market. Nearly all metropolitan areas are now considered “highly concentrated”, and in many regions a single insurer controls a substantial share of the market. In some cases, one company covers half or more of all enrollees. Medicare Advantage markets show a similar pattern, though with slight improvements compared to previous years. While the number of highly concentrated markets has decreased marginally since 2017, the vast majority still lack robust competition.
AMA CEO and Executive Vice President, John J. Whyte, M.D., M.P.H., notes, "In the vast majority of metropolitan areas across the country, health insurers hold outsized market share – leaving patients with fewer choices and higher costs. When one or two companies call the shots, premiums rise, options shrink, and patients suffer. Strengthening competition—not consolidation—is the path to lower costs and improved access."
For more than 20 years, the AMA analysis has been a helpful resource to researchers, policymakers, and regulators as they work to identify markets where mergers and acquisitions involving health insurers may cause competitive harm to consumers and providers of care.
As MedChi continues to advocate for Maryland's patients and physicians, I encourage everyone to read this study. By understanding advantages and current states of both Commercial and Medicare Advantage Markets, we can better advocate for our patients and physicians.
Gene M. Ransom III
CEO
MedChi, The Maryland State Medical Society
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