Haris Ashley
There are many agencies and companies that handle medical insurance. For example, in Philadelphia, there are at least 11 health insurance agencies, including Insurance Xchange, Troast-Singley Insurance Agency, Insurance 5000, and The Perzel Agency, Inc. Nationally, there are many more, including Aetna, Cigna Healthcare, and UnitedHealthcare. These companies offer a wide range of insurance plans and products that focus on different aspects of well-being, such as medical, dental, pharmacy, behavioral, and supplemental health. Employers can also choose to provide group health insurance plans for their employees.
| Characteristics | Values |
|---|---|
| Date of search | 2021-07-22 |
| Location | Philadelphia, PA |
| Number of agencies | 11 |
| Example agency names | Insurance Xchange, Troast-Singley Insurance Agency LLC, Insurance 5000, The Perzel Agency Inc., Philadelphia Life and Health Inc., Michael Melle |
| Example agency services | Health insurance coverages such as indemnity and managed care plans, Medicare Supplement, long-term disability, and individual health |
| Example insurance company names | Aetna, Cigna Healthcare |
| Example insurance company services | Dental plans, Medicare, health insurance plans |
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What You'll Learn
Employers offering group health plans
A "Group Health Plan" (GHP) is health insurance offered by an employer, union, or association to its members while they are still working. GHP coverage is based on current employment. Employers with 20 or more employees are required by law to offer current workers and their spouses aged 65 or older the same GHP health benefits as younger employees.
Group health plans are employee welfare benefit plans established or maintained by an employer or employee organization (such as a union) that provide medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise. Most private sector health plans are covered by the Employee Retirement Income Security Act (ERISA). ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. The U.S. Department of Labor's Employee Benefits Security Administration is responsible for administering and enforcing these provisions of ERISA.
For employers, group health plans can be a great way to provide affordable, flexible health insurance with comprehensive coverage for their employees. These plans can help lower costs, ease administration, and keep employees healthy and satisfied. Additionally, they can improve employee health, increase engagement, and reduce costs through proactive care strategies, data modelling, and human-centred connections.
Some companies that offer group health insurance plans for employers include HealthPartners, which offers group medical and dental insurance to organizations based in Minnesota, Wisconsin, North Dakota, South Dakota, and Iowa. They offer plans for businesses of all sizes, with a wide variety of designs, networks, and funding options.
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Medicare and Medicaid
Medicare is a federal health insurance program that primarily covers citizens aged 65 and over. It also covers younger people with disabilities and those with specific health conditions. The program provides essential health benefits, including hospital stays, doctor visits, and prescription drug coverage. Medicare consists of several parts, including Part A (Hospital Insurance) and Part B (Medical Insurance). Depending on their specific needs, individuals can choose between Original Medicare and Medicare Advantage plans, which offer different options for receiving Medicare benefits.
Medicaid, on the other hand, is a joint federal and state program that assists individuals and families with limited income and resources in covering their medical costs. The eligibility criteria vary from state to state. While the federal government sets general rules, each state operates its own Medicaid program. Individuals eligible for Medicaid may include low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid covers expenses that Medicare typically does not, such as nursing home care and personal care services. Individuals with limited resources who qualify for both Medicare and full Medicaid coverage are considered "dually eligible." In such cases, Medicare pays first for Medicare-covered services, while Medicaid pays last, covering any remaining costs.
The specific details of Medicare and Medicaid, including eligibility requirements, enrollment processes, and covered benefits, can be found on the official Medicare and Medicaid government websites. These programs play a crucial role in ensuring that citizens, especially those with limited resources, have access to essential healthcare services.
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Private health insurance agencies
Aetna
Aetna is a well-known private health insurance company that offers a range of health insurance plans to meet the unique needs of its customers. They provide trusted care, guidance, and quality health insurance benefits. Aetna's Clinical Policy Bulletins (CPBs) guide coverage decisions, determining the medical necessity of certain services or supplies. They also offer Medicare plans and dental insurance.
Kaiser Permanente
Kaiser Permanente is highly regarded for its integrated healthcare system, which provides health insurance coverage and services through a network of hospitals, clinics, and physicians. They emphasize preventive care and wellness programs, and members typically pay a fixed monthly premium. Kaiser Permanente is ranked highly for customer service and has low complaint levels, indicating high customer satisfaction.
Oscar
Oscar is another private health insurance company that offers Affordable Care Act (ACA) plans. They are known for their competitive pricing and a range of health plans to choose from.
Blue Cross Blue Shield
Blue Cross Blue Shield is a prominent health insurance provider, offering a wide array of health plans and receiving high rankings for their cost structure and breadth of options.
In addition to these agencies, there are numerous other private health insurance companies in the market, each providing different types of plans and coverage options. These agencies often compete based on pricing, customer satisfaction, and the range of benefits they offer. Small businesses and organizations may face challenges in budgeting for group medical insurance but can explore alternatives like HRAs (Health Reimbursement Arrangements) to reimburse employees tax-free for out-of-pocket medical expenses.
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State Departments of Insurance
In the United States, each state has its own Department of Insurance, which is responsible for regulating the insurance industry within that state. These departments play a crucial role in overseeing insurance companies, protecting consumers, and ensuring fair and equitable insurance practices. While specific responsibilities may vary slightly from state to state, there are some common functions that these departments typically perform.
One of the key roles of State Departments of Insurance is to license and regulate insurance companies operating within their jurisdiction. This includes setting standards for insurance products, reviewing and approving insurance rates, and ensuring that insurance companies comply with state laws and regulations. They also typically handle consumer complaints and inquiries related to insurance matters, providing a level of protection and recourse for policyholders.
Furthermore, State Departments of Insurance often collaborate with other state agencies and stakeholders in the insurance industry to promote stability and growth in the insurance market. They may also be involved in emergency management and response, helping to ensure that insurance companies are able to meet their obligations to policyholders in the event of natural disasters or other crises. By overseeing the insurance industry at the state level, these departments play a vital role in protecting consumers and maintaining the stability of the insurance market.
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Health insurance companies' market share
In the United States, health insurance is typically handled by private companies, with the largest market share held by UnitedHealth Group Inc. as of 2022. Other major players in the US health insurance market include Ellevance Health, CVS (Aetna), and Kaiser. These companies compete for market share by offering various plans and coverage options to consumers. Aetna, for example, provides health insurance plans that cover a range of medical services and supplies, with Clinical Policy Bulletins (CPBs) defining their clinical policies and medical necessity determinations.
The market share of these health insurance companies can vary from year to year, and it's worth noting that state-level enrollments can also impact their overall position in the market. While UnitedHealth Group Inc. held the top position in 2022, Kaiser became the largest health insurance company in the US in terms of membership in 2023, with Ellevance and UnitedHealth following closely behind.
In the state of California, the Department of Insurance plays a role in regulating and providing information about health insurance providers, although they cannot guarantee the accuracy of translations on their website.
In the Indian market, health insurance is also provided by both standalone insurers and general insurers. Standalone health insurers like Star Health, Care Health, and Niva Bupa have been successful in the retail segment. As of 2024, general insurers held 70% of the market share, while standalone insurers had a 30% share. As of April-Sept 2025, The New India Assurance maintained its position as the market leader, with Star Health & Allied Insurance and Oriental Insurance Company as the next largest health insurance providers.
Overall, the health insurance market is highly competitive, with companies vying for market share by offering diverse plans and coverage options to meet the unique needs of their customers. The market leaders can vary over time, with factors such as enrollment numbers, premium collections, and customer preferences influencing their position in the market.
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Frequently asked questions
Some agencies that handle medical insurance in Philadelphia, PA, include Insurance Xchange, Troast-Singley Insurance Agency, Insurance 5000, The Perzel Agency, Philadelphia Life and Health Inc., and Michael Melle.
Some well-known health insurance companies in the U.S. include Aetna, Cigna Healthcare, and UnitedHealthcare.
The Department of Insurance provides information on licensed insurers providing health insurance coverage. It is unable to guarantee the accuracy of translations on its website.
With group health insurance, employers choose a medical plan for their organization and offer coverage to their employees and eligible dependents at a reduced rate. Individual health insurance is purchased by an individual directly from an insurance carrier, licensed agent, or broker.
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