One in three Americans receives health coverage through one of 33 independent Blue Cross Blue Shield companies.
Here are 101 things to know about BCBS’ corporate structure, history and more.
This story was first published in April 2023 and last updated in April 2025.
Structure
1. The Blue Cross Blue Shield Association is made up of 33 independent BCBS companies. BCBS affiliates are locally owned and operated.
2. BCBS affiliates operate in all 50 states, the District of Columbia and Puerto Rico.
3. As of 2023, BCBS companies had 115 million members, accounting for 1 in 3 Americans.
4. BCBS companies use different operating models. Some are nonprofits, or mutual companies owned by their members. Others operate as for-profit.
5. Elevance Health, which operates 14 BCBS affiliates, is publicly traded.
6. Kim Keck became president and CEO of the BCBS Association in 2021. Prior to leading the association, she was president of BCBS Rhode Island.
7. The BCBSA is headquartered in Chicago, with offices in Washington, D.C.
8. The BCBSA has around 1,000 employees.
9. BCBS affiliates employ more than 150,000 people nationwide, making it one of the top 20 employers in the United States.
History
10. The first hospital prepayment plan was founded in 1929 by Justin Ford Kimball, a vice president at Baylor School of Medicine. Mr. Kimball created a system for Dallas public school teachers to pay 50 cents a month for up to 21 days of hospitalization.
11. The Baylor prepaid plan evolved into the first Blue Cross plan, and the model was picked up by other hospitals.
12. The first Blue Cross plan to include a network of multiple hospitals was created in New Jersey in 1931.
13. BlueCross BlueShield of Minnesota, founded in 1933, claims to be the first to use the Blue Cross name.
14. Blue Shield plans started separately from Blue Cross plans, which only dealt with hospital services.
15. The first Blue Shield plans evolved from employer-organized plans to treat loggers and miners in the Pacific Northwest.
16. Blue Cross and Blue Shield plans grew through the 1930s and ’40s, and the two companies began to merge.
17. The Blue Cross Association and the Blue Shield Association began administering the Federal Health Employee Benefit contract in 1959. It is the largest single health plan group in the world.
18. The Blue Cross Association and Blue Shield Association merged in 1982, creating the current BCBSA.
19. All affiliates were required to operate as nonprofits until 1994, when the association allowed members to convert to for-profit status.
Membership by the numbers
20. According to the BCBSA, as of 2025, BCBS companies had network agreements with 1.7 million physicians and hospitals across the country.
21. BCBS companies pay about $600 billion in claims annually.
22. BCBS companies contract with 79 of the Fortune 100 companies.
23. In addition to group commercial plans, BCBS companies offer Medicare Advantage, Medicaid managed care, Medigap, Medicare Part D and exchange plans.
24. In 2023, the BCBS companies had 5.8 million members in the Federal Employees Health Benefits Program,
25. 18 million members through labor unions,
26. 6.8 million members through small business plans,
27. 7.4 million individual market members,
28. 13 million Medicaid members,
29. 4.6 million Medicare Advantage members,
30. 5.3 million Medicare Part D members, and
31. 4 million Medicare supplement, or Medigap, members.
32. More than 81 million BCBS members have access to value-based care from 654,000 providers, as of 2023.
33. Nonprofit Blue Cross Blue Shield plans accounted for 11% of the total Medicare Advantage market in 2025, according to a report from Chartis.
34. Blue Cross Blue Shield of Michigan was the fastest-growing BCBS Medicare Advantage plan in 2025, according to Chartis.
BCBS companies to know
35. Each BCBS affiliate has its own CEO: Here are the leaders in every state.
36. Health Care Service Corp. owns BCBS affiliates in Illinois, Texas, New Mexico, Oklahoma and Montana. It is the largest member-owned insurer in the United States and serves more than 26 million people.
37. Elevance Health operates 14 state BCBS affiliates under the Anthem Blue Cross Blue Shield brand. Anthem offers plans in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin, California and New York. Elevance Health had 32.1 million commercial members in 2022.
38. Highmark operates BCBS affiliates in Pennsylvania, Delaware, New York and West Virginia. Highmark Health Plan is part of parent organization Highmark Health, which also owns Pittsburgh-based Allegheny Health Network. Highmark Health Plan has around 7 million members.
39. CareFirst Blue Cross Blue Shield offers health plans in Maryland, Washington, D.C., and parts of Virginia. The payer has 3.3 million members.
40. Premera BlueCross offers plans in Washington, Oregon and Alaska. Premera has over 2 million members.
41. Cambia Health Solutions operates Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueShield of Washington and Regence BlueShield of Utah. As of 2025, Cambia had more than 2.3 million members.
42. Wellmark Blue Cross Blue Shield offers plans in Iowa and South Dakota. The company has more than 2 million members.
43. Blue Cross Blue Shield of Alabama serves 2.8 million members across the state.
44. Blue Shield of California, a nonprofit payer, has nearly 6 million members.
45. Florida Blue serves more than 6 million members.
46. Blue Cross Blue Shield of Massachusetts, headquartered in Boston, has 3 million members.
47. Blue Cross Blue Shield of Kansas City has over 1 million members in 30 Northwest Missouri counties and two Kansas counties.
48. Blue Cross Blue Shield of Michigan has more than 5 million members.
49. Blue Cross Blue Shield of North Dakota has more than 450,000 members.
50. Blue Cross Blue Shield of South Carolina is the largest commercial insurer in the state.
51. BlueCross BlueShield of Tennessee has more than 3.4 million members.
52. Capital BlueCross serves 21 counties in Central Pennsylvania.
53. The Hawaii Medical Services Association serves 792,055 members, more than half of the state’s population.
54. Horizon Blue Cross Blue Shield of New Jersey has more than 3.8 million members.
55. Independence Blue Cross operates in the Philadelphia region. The company had 8.3 million members as of 2023.
56. Blue Cross Blue Shield of Arizona has more than 2 million customers.
57. Blue Cross and Blue Shield of Arkansas is the second-largest commercial insurer in the state.
58. Blue Cross of Idaho has over 600,000 members. It is separate from Regence BlueShield of Idaho.
59. Blue Cross Blue and Shield of Kansas serves 932,000 members.
60. Blue Cross and Blue Shield of Louisiana serves 1.9 million members. The company was nearly acquired by Elevance Health in 2024, but the deal has stalled.
61. Blue Cross Blue Shield of Minnesota has nearly 2.7 million members.
62. Blue Cross Blue Shield of Mississippi is the second-largest commercial insurer in the state.
63. Blue Cross and Blue Shield of Nebraska is the second-largest commercial insurer in the state and the second largest Medicare Advantage provider.
64. Excellus BlueCross BlueShield has nearly 1.5 million members in upstate New York.
65. Blue Cross and Blue Shield of North Carolina has 4.3 million members.
66. Blue Cross and Blue Shield of Vermont has 228,000 members.
67. Blue Cross Blue Shield of Wyoming had over 138,000 members as of 2020.
Prime Therapeutics and prescription drugs
68. Nineteen Blue Cross Blue Shield plans own Prime Therapeutics, a pharmacy benefit manager.
69. BCBS Nebraska and BCBS Minnesota created the PBM in 1998, and more plans joined as co-owners. Health Care Service Corp. joined as an equity owner in 2004.
70. In December 2022, Prime Therapeutics acquired MagellanRx from Centene in a $1.5 billion deal.
71. In January 2023, the BCBSA and several Blues companies formed Synergie Medication Collective, a contracting organization aimed at bringing down the price of specialty drugs.
Executive moves
72. Florida Blue and GuideWell CEO Pat Geraghty plans to retire at the end of 2025.
73. In March 2025, Blue Shield of California CEO Lois Quam stepped down after just two months in the role.
74. Don George, president and CEO of Blue Cross and Blue Shield of Vermont, will retire at the end of 2025 after serving more than 16 years as the payer’s chief executive.
75. Independence Health Group CEO Gregory Deavens plans to retire at the end of 2025.
76. Blue Cross Blue Shield of Michigan named Tricia Keith as president and CEO at the beginning of 2025.
77. Blue Cross Blue Shield of Louisiana recently appointed Bryan Camerlinck as CEO.
M&A
78. Blue Cross Blue Shield of Michigan is reportedly planning to sell its AF Group subsidiary. AF Group wrote $2.9 billion in direct premiums in 2024 and is the holding company for multiple companies that provide workers’ compensation and other specialty insurance solutions.
79. In March, Health Care Service Corp. purchased Cigna’s Medicare Advantage business for $3.3 billion.
80. Elevance Health acquired Indiana University Health’s health plan in January. The company now operates as part of Anthem Blue Cross.
81. In May, TheLifetime Healthcare Co., parent company of insurers Excellus Blue Cross Blue Shield and Univera, said it plans to merge with Capital District Physicians Health Plan. If approved, the merger would create an organization with nearly 2 million members and 6,000 employees.
82. Blue Cross and Blue Shield of North Carolina purchased more than 50 North Carolina locations of FastMed, a national chain of urgent care clinics.
83. Vermont regulators approved Blue Cross Blue Shield of Vermont becoming a subsidiary of Blue Cross Blue Shield of Michigan.
84. In February, 2024 BCBS Louisiana scrapped plans to be acquired by Elevance Health, after the sale faced scrutiny from physicians and state officials. In August, CEO Bryan Camerlinck said the deal was “completely off the table.”
Antitrust actions
85. The BCBSA and individual BCBS companies have faced legal challenges alleging the companies limit competition. BCBS companies have reached two major settlements in recent years.
86. In August 2022, a federal judge approved a final $2.67 billion settlement agreement with BCBS companies after a decadelong court battle.
87. As part of the settlement, insurers must drop a BCBS Association rule that requires two-thirds of national net revenues from health plans and related services to come from Blue-branded products.
88. The settlement also struck down a rule requiring large employers to work with the Blue insurer that offers coverage where the employer is located so that BCBS companies could avoid competing with one another for large contracts.
89. The U.S. Supreme Court upheld the settlement in June 2024.
90. In October 2024, the BCBS Association reached a $2.8 billion settlement with providers. In addition to the cash settlement, BCBS will implement operational changes, including how BCBS processes claims, communicates, contracts with and makes payments to providers.
92. In March, dozens of health systems filed new antitrust lawsuits against the BCBS Association and its individual companies, opting out of the $2.8 billion settlement. The systems challenged the adequacy of the settlement.
Recent news to note
93. Blue Cross and Blue Shield of North Carolina restructured in March to become a subsidiary of a new parent holding company, CuraCor Solutions.
94. At least seven Blue Cross Blue Shield companies reported financial losses in 2024, facing rising healthcare spending and drug costs.
95. BCBS Michigan began enforcing a long-standing policy that would charge hospitals that repeatedly appeal denied claims.
96. In March, the Tennessee Supreme Court ruled in favor of BCBS Tennessee in a case involving the termination of an employee who emailed state legislators opposing the company’s COVID-19 vaccine mandate.
97. In January, Blue Shield of California restructured. The nonprofit launched a new parent entity, Ascendiun, to oversee its health plan and other companies.
98. At least two BCBS plans, BCBS Michigan and BCBS Massachusetts, are discontinuing coverage for GLP-1 drugs for weight loss, citing high costs.
99. Blue Shield of California fired a top executive for allegedly lying about her medical credentials.
100. BCBS Kansas City and Premera Blue Cross exited the Medicare Advantage market in 2025.
101. A majority of patients taking weight loss drugs discontinue use of their medication before reaching a clinically meaningful health benefit, research published by the Blue Cross Blue Shield Association in May 2024 found
