QUI LUCRUM FACIUNT

The Payers' Ledger

A live accounting of who profits while Rome burns.

The ten companies below collected $1.71 trillion in revenue in FY2025. They booked $21 billion in net profit — a 1.23% margin by design. And they returned roughly all of that profit to their shareholders, the same year American families saw the steepest premium hike in a decade and Medicare Advantage prior-authorization denials rose to 7.7%. Below: their share prices, live. Beneath that: what consumers paid, and what they were refused.

I. The Profit Side — live tape

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Ticker Insurer Price Day Δ Day % FY25 Revenue FY25 Net Income Net Margin 5-Yr Return Returned to Shareholders
FY2025 combined revenue
$1.71T
FY2025 combined net income
$21.0B
Big-5 capital returned to shareholders
$26.96B
dividends + buybacks ≈ 100% of net income

II. The Premium Side — what consumers paid

$26,993
2025 family employer premium
+6.0% YoY · 3rd straight year
+25.5%
Avg ACA marketplace 2026 gross premium increase
Largest increase since 2014
+58%
Projected jump in net ACA premium after subsidy expiration
$113 → $178 / month · could rise +114%
+26%
5-year cumulative employer family premium growth
vs. 23.5% inflation

III. The Denial Side — what consumers didn't get

7.7%
2024 Medicare Advantage prior-auth denial rate
Up from 7.4% (2023), 5.7% (2019)
53M
2024 Medicare Advantage prior-auth determinations
Roughly 1 PA request per MA enrollee
81%
MA denial appeals overturned in 2024
But only ~12% of denials were appealed
6 states
CMS WISeR Model — PA in traditional Medicare
Jan 2026 launch · NJ, OH, OK, TX, AZ, WA

IV. The Tension, in One Sentence

In the same year the ten largest US for-profit insurers returned roughly all of their net income to shareholders, American families saw the steepest premium hikes in a decade and rising prior-authorization denials on the care they tried to use.