Chief executives of major publicly traded health insurance companies logged high pay in 2024 despite sometimes-disappointing financial performances, according to AIS Health’s analysis of proxy statements the companies submitted to the Securities and Exchange Commission.

The CEOs of the seven major national insurers — UnitedHealth Group, The Cigna Group, Molina Healthcare, Centene Corp., Elevance Health, Inc., CVS Health Corp. and Humana Inc., earned a combined $145,996,812 in total compensation in 2024.

UnitedHealth Group CEO Andrew Witty topped the list with $26.3 million in total compensation, an 11.9% increase year over year. The bulk of his payout came in stock awards, which totaled $17.2 million in 2024. His compensation has risen 42.9% since he took the role as president and CEO on Feb. 3, 2021.

The nation’s largest health care company, UnitedHealth brought in a record $400.3 billion in revenue in 2024 amid a year of crisis, including its Change Healthcare unit experiencing the largest health care data breach of all time and the shooting death of its top insurance executive. Analysts deemed UnitedHealth’s first-quarter 2024 earnings report “better than feared” amid heightened utilization in its Medicare Advantage business, and they gave its second-quarter results middling marks. But the disclosure of higher-than-expected medical loss ratios (MLRs) in both the fourth quarter of 2024 and the first quarter of 2025 caused UnitedHealth’s stock price to plummet.

Cigna CEO David Cordani saw his total compensation package rise more than 10.4% year over year, reaching $23.2 million in 2024. In its 2024 fourth-quarter earnings release, the company reported that it recorded a 27% year-over-year increase in revenue. But the insurer’s stock took an 11% tumble on news that it missed its fourth-quarter adjusted earnings per share (EPS) and MLR targets. 

Centene CEO Sarah London earned $20.6 million in total compensation in 2024, representing an 11.02% increase over 2023. Since she was appointed president and CEO in March 2022, her compensation has risen over 55.5%. Centene’s high first-quarter Medicaid MLR worried investors, and its overall MLR in the second quarter was higher than expected. But the firm beat Wall Street expectations in the third and fourth quarter.

Molina CEO Joseph M. Zubretsky saw a slight increase in his total compensation, earning $21.9 million in 2024. Molina, one of the largest managed Medicaid insurers in the U.S., beat expectations in its second and third-quarter earnings reports, yet it had a “disappointing” fourth-quarter performance driven by higher-than-anticipated care utilization among its members. 

Elevance Health CEO Gail Boudreaux saw her compensation drop by almost 6.5% in 2024 compared to 2023. That was largely due to a decline in her non-equity incentive plan compensation, which represents cash annual incentive plan awards earned as a percentage of their respective target awards, according to the company’s proxy statement. The insurer posted solid results in the first quarter and second quarter of 2024, but it struggled with rising MLRs in the third quarter and fourth quarter.

Meanwhile, after several disappointing quarters that were mostly due to challenges in its Aetna segment, CVS replaced its President and CEO Karen Lynch with David Joyner, president of CVS Caremark, in October 2024. Joyner earned $17.8 million in 2024, while Lynch logged $23.4 million.

Humana’s new CEO Jim Rechtin earned over $15.5 million since he assumed the role in July. In January 2024, the insurer surprised investors when it lowered its adjusted earnings per share guidance to about $16 for the year, down significantly from its previous estimate of about $25. Though still facing challenges in Medicare Advantage market, the insurer reported fourth-quarter earnings that slightly exceeded analyst expectations.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

In 2024, the health care sector reported 14 data breaches that involved more than 1 million patient records, representing almost 70% of the U.S. population, according to an AIS Health analysis of data from the HHS Office for Civil Rights (OCR).

In total, there were 734 health care data breaches that were large enough to report to OCR in 2024, a slight decrease compared to 747 breaches in 2023. However, 2024 was the worst-ever year in terms of the number of patients affected, as a data breach targeting UnitedHealth Group subsidiary Change Healthcare affected an estimated 190 million individuals.

In recent years, some of the biggest breaches targeted health care providers and business associates, such as third-party administrators that assist plans with claims processing or consultants that perform utilization reviews for hospitals. In 2024, more than 221 million health care records were exposed or stolen in data breaches at business associates compared to 40 million records in breaches at health care providers.

Breaches caused by hacking and IT incidents have skyrocketed since 2019, reaching 598 incidents in 2024 and becoming the leading cause of data breaches in the health care industry.

The largest health care data breach of 2024 — and of all time — occurred at Change Healthcare. In February, a hacking gang operating as ALPHV/BlackCat breached a server using stolen credentials and moved within the system for several days exfiltrating data before deploying ransomware. The attack then set off weeks of provider payment disruptions nationwide. UnitedHealth spent $3.1 billion responding to the attack in 2024, according to its financial results released in early January.

The second-largest health care data breach of 2024 involved Kaiser Foundation Health Plan, potentially affecting up to 13.4 million people’s protected health information. In May 2024, the health plan notified its members that certain online technologies on its websites and mobile apps may “have transmitted personal information to third-party vendors Google, Microsoft Bing, and X (Twitter),” according to the company.

In September 2024, CMS reported that the health information of almost 1 million individuals was potentially compromised in connection with a data breach affecting its contractor WPS, which handles Medicare Parts A and B claims for beneficiaries in multiple states. The notification came almost 16 months after a security vulnerability was discovered in MOVEit, a third-party file-transfer software used by the contractor. CMS later reported on HHS’s breach portal that the total number of affected people was 3,112,815.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Premiums for many stand-alone Medicare Part D Prescription Drug Plans will go up moderately in 2025, while the number of PDP options for beneficiaries will drop significantly, according to AIS Health’s analysis of the recently released CMS Medicare Advantage and Part D landscape files.

The Inflation Reduction Act, passed in 2022, ushered in a host of policy changes to the Part D benefit that will take effect in 2025: Most notably, Medicare Part D beneficiaries’ out-of-pocket drug costs will be capped at $2,000 annually and Part D plan sponsors will be responsible for 60% (up from 20%) of any costs their enrollees incur beyond that cap. As a result, the Medicare Part D national average monthly bid amount (NAMBA) is projected to increase by $115, nearly 180%, to $179.45 in 2025.

At the same time that it released the 2025 NAMBA, the federal government unveiled the Part D Premium Stabilization Demonstration, which capped premium increases at $35 per month and applied a $15 reduction to the base beneficiary premium for all participating PDPs. In a fact sheet accompanying the release of the landscape files for 2025, CMS estimated that the Part D premium will decline by $7.45 to $46.50 next year, and the average PDP premium will drop by $1.63 to $40.00.

AIS Health’s analysis of CMS data showed that PDP premiums among the 12 national plans will range from $127.23 for Humana Premier Rx Plan to $2.55 for Centene Corp.’s Wellcare Value Script in 2025. The monthly premium for Wellcare Value Script — the largest PDP by enrollment in 2024 — will increase by $1.81 year over year. AARP Medicare Rx Preferred, offered by UnitedHealth Group, will see its premium drop by $15.75, from $104.94 in 2024 to $89.19 next year.

Meanwhile, the number of PDP options for beneficiaries will drop 26% year over year, from 709 in 2024 to 524 in 2025. That is the lowest number of PDPs available since Part D started in 2006.

A KFF analysis of monthly premiums for PDPs in California also painted a mixed picture: Enrollees in eight of the 16 national PDPs offered in 2024 will see their premiums increase by $35 if they do not switch to a different plan in 2025, while enrollees in six other national PDPs will see a premium reduction. SilverScript SmartSaver, offered by CVS Health Corp.’s Aetna, will no longer be available in 2025 and its enrollees will be switched into Aetna’s sole PDP offering for 2025, SilverScript Choice, unless they choose another plan. Because of the switch, those customers’ monthly premium will see a $35 increase, from $18.60 to $53.60. Without the implementation of the Part D Premium Stabilization Demonstration, premium growth would be even more significant, according to KFF.

Rising premiums and fewer options in the PDP market may lead to substantial enrollment shifts, with more enrollees switching from traditional Medicare to Medicare Advantage Prescription Drug plans, the study suggested.

According to AIS’s Directory of Health Plans, the four largest PDP insurers by market share — Centene, Aetna (under the name SilverScript Insurance Company), UnitedHealth Group and Cigna Healthcare — accounted for almost 80% of enrollment as of September 2024. Centene reported year-over-year membership growth of nearly 49.2%, while Aetna saw a double-digit loss at 19.7%. Both UnitedHealthcare and Aetna reduced their PDP offerings in 2025.

This infographic was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.

Privately insured enrollees are generally satisfied with their health plan selection process and benefits, according to recently released data from the Employee Benefit Research Institute (EBRI) and Greenwald Research.

The Consumer Engagement in Health Care Survey found that the majority of adults surveyed obtained their health insurance coverage through their job or a spouse’s job. Most individuals said they were satisfied with various aspects of their health plan coverage. Over half of enrollees were extremely or very satisfied with their open enrollment process.

When selecting plans, good provider networks was the factor valued by the highest share of enrollees (78%), followed by low out-of-pocket costs (73%) and low premiums (72%).

About two-thirds of individuals said they have a choice of health plan. Adults with high-deductible health plans (HDHPs) were more likely to have three or more health plans to choose from, compared with adults with traditional health plans.

Enrollment in health savings account (HSA)-eligible health plans and health reimbursement arrangements (both of which are known as consumer-driven health plans) leveled off in recent years, bouncing between 18% and 19% between 2020 and 2023. Enrollment in HDHPs that were not eligible to be paired with a health savings account (HSA) fell from 12% in 2022 to 9% in 2023.

Among enrollees who opened HSAs, the top reason was to take advantage of employer contributions (60%), followed by saving for future health care expenses (58%) and on taxes (52%). Over 60% of people saw their HSA as a savings account, while 31% viewed it as an investment account, according to the survey.

“Employers have an opportunity to educate their employees on HSAs. Many accountholders feel having more information would make them more likely to invest their unused funds. For non-accountholders, interest remains high when shown important product features,” Greenwald Research CEO Lisa Greenwald said in a statement.

However, employee satisfaction surveys do not always tell the whole story, according to the 2024 State of Employee Health Benefits Report, produced by SureCo, a platform that offers large and medium-sized companies’ personalized health coverage through Individual Coverage Health Reimbursement Arrangements (ICHRAs). The report was based on responses from 1,637 employees, human resources and finance leaders, and benefits consultants.

While about 84% of employees surveyed said they were satisfied with their health care benefits, about 59% said they would leave their current company for another one with better health benefits. Seventy-nine percent of employees said their plan is sufficient to cover medical problems that may come up in the future, however, almost half of them said they’ve considered alternative health coverage outside of their employers’ offerings, according to the report.

Employees’ main concerns included high out-of-pocket costs, limited coverage and accessibility to the services that they need. Eight out of 10 employees said they would prefer to select their own plan from all available options rather than pick from the options their company offered.

The report also noted that to better control the rising health care costs, only 35% of employers were using traditional, fully insured health plans, while another 33% have already moved to self- or level-funded plans.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

The average annual premium for employer-sponsored health insurance in 2024 hit $8,951 for single coverage and $25,572 for family coverage, according to the KFF 2024 Employer Health Benefits Survey. This is the second year in a row that family premiums went up 7%, compared to a 4.5% year-over-year increase in workers’ wages and a 3.2% rise in inflation. Over the past 10 years, growth of the average premium for family coverage outpaced the rate of inflation (52% vs. 32%), while the average family premium and average wages grew at comparable rates (52% vs. 45%).

While employers have seen their total premiums rise steadily, the amount that employees, on average, paid toward their annual premiums has changed little over the past five years. In 2024, employees contributed 16% of the premium for single coverage and 25% of the premium for family coverage, and both were lower than the average contribution levels last year. Employees with single coverage at small firms (under 200 workers) were more likely to enroll in plans with no premium contribution (37%), compared with only 5% of workers at large firms.

The average annual deductible for workers with single coverage was $1,787 in 2024, similar to last year’s $1,735. On average, workers at small firms faced much larger deductibles than workers at larger firms ($2,575 vs. $1,538).

“Employers are shelling out the equivalent of buying an economy car for every worker every year to pay for family coverage,” KFF President and CEO Drew Altman said in a press release. “In the tight labor market in recent years, they have not been able to continue offloading costs onto workers who are already struggling with health care bills.”

To assist their lower-wage employees, some firms offered programs to reduce cost sharing (6%) or to reduce premium contributions (14%) in 2024. Among firms with 200 or more workers, 14% offered a plan with reduced benefits and a low premium contribution to make it more affordable for lower-wage workers.

The growing interest in weight-loss drugs, GLP-1 agonists, along with their hefty price tags, has posed a major challenge for employers. In 2024, only 18% of firms with 200 or more workers covered GLP-1s when used primarily for weight loss. And when they provided such coverage, over half of the polled firms required certain steps before the coverage was approved. Most commonly, the firms asked employees to meet with a professional, such as a dietitian, psychologist, case worker or therapist, before approving a GLP-1 drug prescription.

Among firms with 200 or more workers that did not cover GLP-1s primarily for weight loss, 62% said that they were “not likely” to begin covering these medications for weight loss within the next 12 months, and only 3% say that they were “very likely” to do so.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Kaiser Permanente unveiled plans to acquire Geisinger Health and make it the first member of a new value-based nonprofit health organization called Risant Health, if the deal gains regulatory approval.

Kaiser Permanente’s health insurance products cover more than 11 million people in eight states and the District of Columbia, according to AIS’s Directory of Health Plans. Combined, Kaiser’s seven regional managed care plans form the largest provider-sponsored insurer, enrolling 28.1% of all provider-sponsored lives. It is the largest insurer in the commercial risk market, with over 9 million members. It also ranks as the fifth-largest Medicare Advantage health plan in the nation.

Geisinger Health operates the ninth-largest insurer in Pennsylvania, Geisinger Health Plan, which currently serves 615,147 members. Under the deal, Geisinger will keep its brand identity and its mission.

As one of the largest nonprofit health systems in the U.S., California-based Kaiser Permanente operates 39 hospitals and 737 medical clinics across eight states and the District of Columbia. In 2022, the organization reported $95.4 billion in operating revenue, a $1.3 billion operating loss and a $4.5 billion net loss. The nonprofit Geisinger Health owns 10 hospital campuses in Pennsylvania, with service areas mainly covering the northeast and central regions of the state. It reported $6.9 billion in operating revenue during 2022 but swallowed a $239 million operating loss and a $842 million net loss.

The Kaiser Permanente-Geisinger deal reflects the rebounding trend in health care merger and acquisition activity post-pandemic. A Kaufman Hall report showed that 2022 logged a total of 53 announced transactions, with a combined revenue of transacted hospitals over $45 billion. Fifteen percent of the announced transactions were a “mega merger,” in which the smaller party has annual revenues in excess of $1 billion, just below 2021’s historic high of 16.3%.

The report also highlighted the trend of cross-market transactions, which connect health systems located in different geographic areas with little or no overlap between markets. In 2022, Advocate Health in the Midwest and Atrium Health in North Carolina closed their mega merger to create a 67-hospital health system. UnityPoint Health in Iowa and Presbyterian Healthcare Services in New Mexico just proposed merging last month.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

The number of dual eligible beneficiaries — people who are enrolled in both Medicare and Medicaid coverage — increased from 10.4 million in 2016 to 12.8 million in 2024. And a growing share of them chose a private Medicare Advantage plan rather than a traditional fee-for-service Medicare plan, according to a recent analysis from The Commonwealth Fund.

Dual eligible enrollees typically require more intensive and costly health care than the average Medicare enrollee. To qualify as a dual enrollee, a person must be at least 65 years old or have a qualifying disability or medical condition, have a low income and limited resources. Between 2013 and 2021, the percentage of dual eligible beneficiaries covered by a MA plan more than doubled, from 24% to 51%.

According to AIS’s Directory of Health Plans, the top five insurers with the largest dual eligible memberships — UnitedHealth Group, Humana Inc., Elevance Health, Inc., CVS Health Corp.’s Aetna and Centene Corp. — accounted for almost 75% of enrollment as of June 2024. Six of the top 10 health plans saw double-digit growth year over year, while Aetna reported a membership gain of nearly 90.7%.

Dual eligible beneficiaries in MA plans and in traditional Medicare, on average, reported similar ratings of satisfaction with medical care and Part D prescription drug coverage, the report showed. Most dual eligible beneficiaries were able to get needed care, while a larger percentage of enrollees covered by traditional Medicare experienced delays in care due to cost than those covered by MA.

While all dual eligible enrollees receive standard Medicare benefits, they have many options for their primary health insurance, including traditional Medicare, MA and specialized MA plans for individuals with greater and specific health care needs. A Dual Eligible Special Needs Plan (D-SNP) is the most common type of specialized MA plan by far.

The type of Medicare primary health insurance that dual eligibles chose has changed significantly between 2009 and 2021, according to an Urban Institute analysis. Since January 2009, traditional Medicare has been losing dual eligible beneficiaries in all states, with Hawaii and South Carolina seeing enrollment decrease by over 50 percentage points. As of December 2021, Hawaii, Florida, Tennessee, Alabama, Louisiana, Arizona and New York reported that more than 40% of their dual eligible enrollees were covered by D-SNPs.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Health Care Service Corp. has completed its acquisition of The Cigna Group’s Medicare business, which significantly expanded HCSC’s footprint and boosted its Medicare enrollment.

The $3.7 billion purchase of Cigna’s Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D and CareAllies businesses was announced more than a year ago. Divesting these assets “streamlines The Cigna Group’s portfolio and enables it to drive further innovation to support customers,” Cigna stated on March 19.

Cigna’s Medicare business covers more than 4.1 million lives across all states and Washington, D.C., according to the latest data from AIS’s Directory of Health Plans (DHP). Although the insurer’s total MA market share was small compared with other national competitors, it is the fourth-largest insurer in the stand-alone Medicare Part D Prescription Drug Plan (PDP) market, with over 2.9 million enrollees. With the purchase, HCSC now covers more than 5.1 million lives across the three Medicare product lines, according to DHP data.

As the parent company of five Blue Cross Blue Shield insurers — serving Illinois, Montana, New Mexico, Oklahoma and Texas — HCSC is a significant player in these states, but its new acquisition gives it access to members in all states and Washington, D.C. With the addition of Cigna’s MA and Medicare PDP lives, HCSC now is the second-largest insurer in New Mexico and Texas, holding 21.8% and 18.4% of the state’s Medicare business, respectively, according to DHP data. In both Montana and Oklahoma, it ranks third with about 12.0% of the state’s market share.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Over the first 10 years of the Affordable Care Act marketplaces, enrollment nationwide has almost tripled, from 8 million individuals in 2014 to 21.4 million in 2024, according to an HHS report.

While the ACA initially envisioned the marketplaces to be developed by states, it also provided states with the option to participate in the federally facilitated marketplace, HealthCare.gov. In 2014, 14 states and the District of Columbia chose to operate their own state-based marketplaces (SBMs). In 2024, there are 19 SBMs.

Federal policy changes have played a key role in the performance of the ACA marketplaces. In 2014, about 5.4 million people enrolled in marketplace health insurance in HealthCare.gov states and 2.6 million enrolled in SBMs. Yet between 2017 and 2020, the reduction in funding for marketing and the elimination of federal cost-sharing payments to health plans led to enrollment decreases.

But since the COVID-19 pandemic, several policies aimed at expanding health care coverage have contributed to membership increases for four consecutive years. By end of the annual open enrollment period in 2024, 21.4 million individuals had selected or were automatically reenrolled in a marketplace plan. More than 5 million people were new consumers, an increase of 41% from 2023.

In the early years of the ACA, three-quarters of HealthCare.gov enrollees lived in markets with three or more health plan issuers, while 7% were in markets with only one. By 2016, only 2% of enrollees lived in markets with just a single issuer. The trend reversed in 2017, when some major national insurers — such as CVS Health Corp.’s Aetna and UnitedHealth Group — pulled back from the marketplaces, leaving over 1,000 counties in HealthCare.gov states with only one issuer in 2018.

However, the number of issuers participating in the ACA has climbed since 2019, as several insurers chose to rejoin the market and expand their coverage footprints, according to the Robert Wood Johnson Foundation’s ACA Marketplace Participation Tracker.

Centene Corp. — the country’s largest ACA exchange insurer — gained nearly 1.1 million new members from the first quarter of 2019 to 2023, according to AIS’s Directory of Health Plans. Aetna, which rejoined the marketplaces in 2022, reported year-over-year membership growth of nearly 3,122% and ranked as the fourth largest ACA insurer in 2023.

Since the establishment of the ACA marketplaces, over 85% of HealthCare.gov enrollees have received subsidies to cover their premiums each year. The expansion of subsidy eligibility to enrollees with household incomes above 400% of the federal poverty level further increased the share of enrollees receiving financial assistance. By 2024, 95% of HealthCare.gov enrollees gained subsidies, according to the HHS report.

Average premiums, both before and after subsidies, began to fall in 2019, partially due to increased insurer participation. The average premium after subsidies was 17% of the gross premium in 2023, compared to 36% in 2015.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

The CEOs of seven major publicly traded health insurance companies together received more than $144 million in total compensation in 2023, AIS Health’s Executive Compensation Database shows. The database includes major health insurers’ executive compensation from 2019 to 2023 — collected from individual companies, state insurance documents and U.S. Securities and Exchange Commission filings — and their national membership information as of the third quarter of 2024, per AIS’s Directory of Health Plans. The database will be updated annually.

Several states do not disclose compensation data for specific executives at health insurance companies or do not collect compensation data. Some insurance companies made leadership changes over the years.

Select or type an insurer’s name to see detailed compensation information of the firm’s CEO in 2023 and how top executives’ compensation has changed over the years. AIS Health also tracks director compensation information of health insurance companies.