Cigna vs UnitedHealthcare: how do they compare for employers?

Cigna and UnitedHealthcare are both national carriers with their own pharmacy businesses, so on paper they can look alike. For an employer the bigger differences are which group sizes each one sells to, how large each is, and how each has been changing its business over the past year.

At a glance

Size and focus

The American Medical Association’s latest study of the commercial market names UnitedHealth Group as the largest commercial health insurer in the country, with about 16%, and puts Cigna fourth, with about 9% of the market (2024 data).

Both carriers are now mainly in the business of running self-funded plans for employers. At the end of 2025 about 79% of Cigna’s medical customers were in self-funded (ASO) plans. UnitedHealthcare reported 22.2 million self-funded and 7.6 million fully insured commercial members at September 30, 2026, and has said it is deliberately shrinking its fully insured book after repricing it for 2026.

Small employers

UnitedHealthcare sells fully insured, level-funded and self-funded plans, including to small businesses. Its level-funded line is called UnitedHealthcare Level Funded.

Cigna has almost left fully insured small group. Its small group page now lists plans only for Arizona, and it says it stopped offering new traditional small group plans in Georgia and Tennessee from November 1, 2025. Cigna describes its employer business as mainly mid-size and large groups. It also sells level-funded plans.

Networks

Both carriers run national networks. The network numbers each carrier quotes are national totals from its own analysis, and the two count differently, so they do not compare directly. They also say nothing about whether a given doctor or hospital in your county is in network.

Pharmacy and international business

Each carrier’s parent owns its pharmacy benefit manager: Express Scripts at Cigna, part of its Evernorth business, and Optum Rx at UnitedHealth Group. Cigna also has a long-standing international business serving employers with staff abroad.

How members and raters score them

In J.D. Power’s 2026 commercial member study, Cigna tied for the highest score in Florida (with Florida Blue). UnitedHealthcare was rated in all 22 regions but was not the top plan in any. J.D. Power’s separate 2026 digital experience study ranked Cigna first among commercial plans.

On financial strength, AM Best rates both carriers’ main insurers A (Excellent). UnitedHealthcare’s rating was lowered from A+ in August 2025, which AM Best linked to weaker operating results, driven largely by Medicare Advantage costs, and to governance and management changes.

Recent changes worth knowing

• UnitedHealthcare changed its group CEO in May 2025, repriced its fully insured business for 2026, and says Oxford small group plans in Connecticut will be replaced by UnitedHealthcare-branded plans from 2027.
• Cigna sold its Medicare business to HCSC in March 2025, is leaving the individual market from 2027, named a new CEO from July 2026, and stopped new small group sales in Georgia and Tennessee.

Questions to ask a broker about these two carriers

1. Will both carriers quote a group our size in our state?
2. Which of my employees’ doctors and nearest hospitals are in each carrier’s network?
3. Which funding types will each carrier offer a group our size in our state?
4. How have each carrier’s renewals run for similar groups here this year?
5. Which pharmacy benefit manager comes with each carrier’s plans?

Our group health insurance quotes form connects you with a licensed broker who can answer these for your business.

How we write these: every comparison uses the carriers' own published information, their parent companies' filings and independent surveys, each listed below with its date. We are not paid by, affiliated with or endorsed by any carrier, and we do not rank them, describe their plan benefits or recommend any plan. Carrier and product names are trademarks of their owners. Plans, networks and prices vary by state, county and group size: only a licensed broker or the insurer can say what is available to your business and explain its terms.