Life and health insurance market in the U.S
In 2021, 52% of the population reported having life insurance coverage. There is, however, a decline in overall coverage at each income bracket.
Three major product families dominate the market:
- annuity products that pay out a stream of benefits to recipients,
- health and disability coverage,
- traditional life products, that is, death and life policies.
With 217 billion USD, accident and health guarantees represent 9.46% of the turnover achieved by life insurers. The premiums of annuity considerations have progressed by 12.1% compared to 2020.
With 217 billion USD, accident and health coverage represents 9.46% of the turnover collected by life companies. In the United States, accident and health products are mainly provided by insurance companies specialized in this class of business.
The conventional life and death products totaled 18.8% of the total life premiums in 2021, amounting to 210 billion USD.
The other products worth 360 billion USD include savings-type contracts, hence their high share in the life market (32%).
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U.S life and health insurance: direct premiums by class of business
In billions USD
| 2020 | 2020 share | 2021 | 2021 share | |
|---|---|---|---|---|
| Annuity considerations | 291 | 28.14% | 326 | 29.32% |
| Accident and health | 212 | 20.50% | 217 | 19.46% |
| Life insurance | 193 | 18.67% | 210 | 18.88% |
| Other products | 338 | 32.69% | 360 | 32.34% |
| Total | 1 034 | 100% | 1 113 | 100% |
Source: National Association of Insurance Commissioners (NAIC)
Read also | United States: top 10 life insurance companies
U.S life insurance market: technical results
The growth of 10.15% in financial and other income is the reason why the life insurance branch has maintained, with the exception of 2020, a net result in the range of 37 to 44 billion USD over the last five years.
The return on equity (ROE) lost more than two points between 2017 and 2021.
In billions USD
| 2017 | 2018 | 2019 | 2020 | 2021 | |
|---|---|---|---|---|---|
| Premiums | 859.0 | 909.6 | 968.3 | 1 034.6 | 1 113.0 |
| Earned premiums | 607.8 | 613.5 | 691.9 | 635.9 | 649.7 |
| Net financial products | 182.3 | 187.4 | 186.7 | 186.0 | 200.8 |
| Ceded reinsurance | 223.9 | 282.4 | 253.0 | 308.8 | 391.1 |
| Other income | 49.2 | 44.0 | 48.7 | 55.0 | 57.5 |
| Total income | 839.9 | 903.9 | 921.9 | 881.2 | 945.7 |
| Total expenses | 759.4 | 839.7 | 842.8 | 825.2 | 873.9 |
| Net result before taxes | 63.0 | 46.0 | 61.0 | 38.0 | 53.9 |
| Net result after taxes* | 42.1 | 37.9 | 44.7 | 22.1 | 37.4 |
| Return on equity (ROE) | 9.4% | 7.1% | 9.1% | 3.9% | 6.9% |
(1) Including other deductions
Sources: NAIC, iii.org, S&P Global Market Intelligence
Life insurance in the U.S: Breakdown of premiums per company
Similarly to the non-life class of business, the life insurance industry in the USA remains condensed with the 10 largest groups accounting for 53.2% of the 459.6 billion USD of premiums recorded in 2021. For the same year, the top 100 insurers accounted for almost all the life premiums, that is 97.4%.
Metropolitan Life Insurance Company (MetLife), the first life insurance company, is realizing 97.8 billion USD of premiums, that is, a share of 11.3%.
In millions USD
| Rank | Group/company | Premiums | Market share |
|---|---|---|---|
| 1 | MetLife Inc. | 97 860 | 11.3% |
| 2 | Equitable Holdings | 83 179 | 9.6% |
| 3 | Prudential Financial Inc. | 59 387 | 6.9% |
| 4 | Massachusetts Mutual Life Insurance Co. | 41 683 | 4.8% |
| 5 | New York Life Insurance Group | 38 855 | 4.5% |
| 6 | Athene Holding Ltd. | 34 742 | 4.0% |
| 7 | Principal Financial Group Inc. | 26 535 | 3.1% |
| 8 | Western & Southern Financial | 26 469 | 3.1% |
| 9 | Nationwide | 25 745 | 3.0% |
| 10 | American International Group (AIG) | 25 205 | 2.9% |
U.S health and accident insurance market
According to the NAIC, the American market has 1127 specialized health insurance companies offering various coverages and plans: comprehensive health insurance, dental plan, vision plan, federal employee health insurance plan FEHBP, Medicare, Medicare Supplement, Medicaid, etc.
As of 31 December 2021, this activity of health and bodily injury insurance generated 900.09 billion USD in premiums. This figure represents a 7.83% progression compared to 2020 (835.72 billion USD).
The three largest premium increases in 2021 have been achieved by Medicaid (+13%), Medicare (+12%) and by the Individual Health All Risk coverage (+3%). The overall premium growth can be attributed to increased enrollment and premium rates.
Health and accident written premiums by category
In millions USD
| 2021 | 2020 | 2019 | 2018 | 2017 | |
|---|---|---|---|---|---|
| Individual Comprehensive | 84 074 | 82 026 | 72 722 | 76 017 | 68 660 |
| Group Comprehensive | 165 556 | 165 854 | 166 717 | 165 339 | 162 605 |
| Medicare Supplement | 12 679 | 12 068 | 11 546 | 10 807 | 10 596 |
| Vision | 2 889 | 2 619 | 2 654 | 2 561 | 2 410 |
| Dental | 14 765 | 13 640 | 14 048 | 13 855 | 14 090 |
| FEHBP | 44 046 | 42 645 | 41 218 | 38 942 | 37 860 |
| Medicare | 281 224 | 251 295 | 219 554 | 192 253 | 170 413 |
| Medicaid | 273 974 | 242 732 | 208 695 | 192 181 | 180 535 |
| Other health schemes | 20 499 | 21 340 | 20 170 | 18 880 | 18 142 |
Source: NAIC
