The US’s six largest health insurers reported massive profits last year, doling out billions on stock buybacks and dividends. That hasn’t stopped them from pushing for sharp hikes to Americans’ insurance premiums.
The six largest health insurers reported more than $1 trillion in revenue and more than $31 billion in net income last year — and are now pushing to raise Americans’ premiums by as much as 66 percent for some policies, according to recent state regulatory filings. The proposed increases come as insurers dole out billions to further enrich top brass and shareholders through stock buybacks and dividends.
In all, Affordable Care Act (ACA) marketplaces across the country are projected to see the largest rate hikes in more than five years, driving up out-of-pocket premiums for individual plan policyholders by more than 75 percent on average, according to data compiled by the Kaiser Family Foundation. More than 24 million Americans who don’t have employer-sponsored health insurance rely on the ACA marketplace for coverage.
Many health insurers point to rising costs associated with President Donald Trump’s global tariffs and expiring federal premium tax credits, which they claim will significantly threaten their ability to remain competitive.
State insurance regulators have the power to reject requests for “excessive” health insurance premium increases in the marketplace.
Meanwhile, as claim denials, prescription drug prices, and out-of-pocket spending rise, a startling number of Americans say it is difficult to afford their health care bills, while more than half of those with health insurance say at least 10 percent of their monthly spending goes toward health care alone.
The Lever previously reported that the industry’s top earners have raked in more than $371 billion in profits since the ACA’s passage.
Big Rate Hikes, Big Profits
According to health insurers, rates are rising largely because an expanded federal tax credit for individuals and families who might otherwise not be able to afford insurance through the ACA marketplace is set to expire at the end of the year (unless Republican leaders in Congress intervene). This credit reduced health insurance premiums for more than 19 million people last year, or 92 percent of all ACA policyholders, and without it, insurers argue that they can’t afford to cover the bill — instead passing on increased costs to consumers.
That’s what many health care insurers admitted to in their state filings requesting marketplace premium rate hikes. However, insurers’ financial reports show they’re generating billions of dollars in revenue and enriching top shareholders — not policyholders — through stock buybacks and dividends.
Anthem plans are seeing sharp rate hikes across multiple states. For example, HMO Colorado — a subsidiary of Elevance Health, formerly known as Anthem — has proposed an average premium increase of more than 33 percent for individuals. In Maine, Anthem is seeking an 18 percent average rate increase, citing the expiration of federal premium tax credits.
Last year, Elevance Health, which operates Anthem Blue Cross Blue Shield plans across fourteen states, including Colorado and Maine, generated $175 billion in revenue, a nearly 8 percent increase from 2023. In just the first quarter of 2025, Elevance Health drew in over $48 billion in revenue, up 15 percent from the same time in 2024 — and already this year, the company has distributed over $1.2 billion to its shareholders through stock buybacks and dividends.
“The increases for the quarter and year were driven primarily by higher premium yields,” the company stated in its earnings report.
Meanwhile, in Arkansas, USAble Mutual Insurance Co., an affiliate and partner of Anthem Blue Cross Blue Shield, requested to raise premium rates by an average of 25 percent for nearly 100,000 policyholders. The insurer blamed, in part, “reduced member cost-sharing” brought on by a new law banning Arkansas pharmacies from owning their own pharmacy benefit managers, the prescription drug price–negotiating middlemen charged with inflating medication costs.
UnitedHealthcare’s premium rates on the marketplace are also set to rise in some states. In New York, the insurer has proposed a rate hike of more than 66 percent for some policyholders, and in Washington, the company proposed a 37 percent rate increase. Meanwhile, UnitedHealthcare’s parent company, UnitedHealth Group, reported a revenue of more than $400 billion in 2024, 77 percent of which came from premiums, according to the company’s earnings report.
The health care conglomerate, which is the largest insurer in the nation, experienced a financially turbulent year in 2024 after an expensive cyberattack and the murder of one of its executives. That didn’t stop UnitedHealth Group from increasing its annual returns to shareholders, spending $9 billion on stock buybacks and $7.5 billion in dividends.
Cigna, which requested a 29 percent average premium rate increase for individual ACA plans in Colorado, is rebounding after a weak 2024, generating $1.3 billion in profits in the first quarter of 2025 after putting up a $277 million loss at the same time last year. Despite its troubles last year, Cigna generated $3 billion in profits and spent a whopping $7 billion on stock buybacks, along with $1.5 billion on dividends.
Meanwhile, one of the biggest insurers in the country has given up on the ACA marketplace entirely. CVS Health, which acquired Aetna in 2018, said the insurer will exit the marketplace next year, leaving approximately one million people in seventeen states to find new coverage.
This article was first published by the Lever, an award-winning independent investigative newsroom.
