A single insurer in Texas holds 51% to 88% of the PPO market share in all 26 metro areas – following the national pattern of consolidation that favors large insurance companies, according to the American Medical Association’s latest analysis.
The AMA Competition in Health Insurance report released Dec. 16, 2025, looked at 384 metro areas across the U.S., finding that “[i]n 91% of markets, at least one insurer had a market share of at least 30%, and in 47% of markets, one insurer had a share of 50% or more.”
For combined insurance products (e.g., PPO, HMO, point of service, and marketplace exchange plans), Health Care Service Corporation (HCSC) – which oversees Blue Cross and Blue Shield of Texas – holds a plurality or majority share in each of the 26 Texas metro areas identified, from 37% in Austin-Round Rock-San Marcos to 74% in Abilene.
For PPO product markets only:
- HCSC holds 60% of the market share;
- Aetna (part of CVS Health) has 19% of the market share, and is second to HCSC in 13 of the 26 markets, topping out at a 30% market share in El Paso; and
- Cigna is second to HCSC in 10 markets, highest in Dallas-Fort Worth-Arlington at 23%.
“What we see again this year is clear,” wrote John Whyte, MD, AMA’s CEO and executive vice president, in the report introduction. “Across the country, the vast majority of health insurance markets remain highly concentrated. In many communities, just one or two insurers hold outsized market power. When that happens, patients, employers and physicians feel the consequences – higher premiums, fewer choices, and lower physician earnings and employment.”
Coupled with the potential expiration of enhanced premium tax credits for Affordable Care Act marketplace exchange plans, and the current climate makes the Texas Medical Association’s advocacy – and the engagement of member physicians – more important than ever, adds Marcial Oquendo Rincon, MD, chair of TMA’s Council on Socioeconomics.
“The more participation that we have from our colleagues, the more weight that we can put toward legislative advocacy in light of the growth of these massive payers,” he said.
For assistance with insurance payment problems, contact TMA’s Physician Payment Resource Center.
Last Updated On
January 14, 2026
Originally Published On
January 14, 2026
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.