The advancement of the Healthy China strategy is inseparable from the high-quality development of commercial health insurance. Within the insurance industry, commercial health insurance has become a pivotal force driving market growth and building the eldercare ecosystem. On January 22, the Insurance Association of China convened a symposium on the high-quality development of health insurance, highlighting that over the past decade, commercial health insurance has achieved an average annual compound growth rate exceeding 20%, with over 11,000 medical insurance products available for sale, forming a solid pillar of health protection for the public.
In recent years, commercial health insurance has continuously expanded its coverage scope and enhanced its health protection service capabilities. Most mainstream medical insurance products on the market now include coverage for new technologies, new drugs, and new medical devices, encompassing high-value treatments such as tumor-targeted drugs and proton/heavy ion therapy. Preliminary estimates suggest that by 2025, the total claim payout by commercial health insurance for innovative drugs and devices will reach approximately 14.7 billion yuan, marking four consecutive years of rapid growth with an annual compound growth rate of 70%.
So, how exactly is commercial health insurance integrating these new technologies, drugs, and devices? Standing at the new starting point of the 15th Five-Year Plan in 2026, a thorough review of commercial health insurance is necessary.
In a recent interview, Ye Hai, a Senior Global Partner at McKinsey & Company, defined the current industry cycle with one phrase: the era of resilient growth. Corporate growth logic must shift from "broad expansion" towards more precise, differentiated, and financially sound value-based segmented growth.
This assessment aligns closely with the reality of China's commercial health insurance market. In 2025, premiums for China's commercial health insurance are expected to surpass the one trillion yuan milestone for the first time. Behind this landmark achievement, the industry has moved beyond the "golden era" of rapid, aggressive expansion and entered a more sustainable "era of resilient growth." Under the triple pressures of strategic focus on basic medical insurance, an accelerating aging population, and iterative medical technology advancements, a multi-tiered medical security system characterized by functional complementarity and clear boundaries is being rapidly constructed.
Crossing the trillion-yuan threshold presents a picture of "simultaneous hot and cold trends," characterized by slowing growth and structural reshaping.
The "Health Insurance 2026 Outlook Report" from the Taikang Longevity Era Research Institute points out that the commercial health insurance market in 2025 exhibits distinct "hot and cold" characteristics: on one hand, premium growth hit a five-year low, staggering across the trillion-yuan threshold; on the other hand, policy enthusiasm and market expectations for commercial health insurance reached new highs, with the industry's development positioning continuously elevated.
Data shows that as of November 2025, the premium scale of China's commercial health insurance reached 944 billion yuan, a year-on-year increase of 2.39%. This growth rate represents a 6.1 percentage point decline compared to 2024, marking the lowest level in nearly five years. However, based on this trajectory, surpassing one trillion yuan in annual premiums is virtually certain.
The fundamental adjustment in the structure of commercial health insurance products is the most core transformation within the trillion-yuan market. The report indicates that in 2025, medical insurance premiums amounted to approximately 455 billion yuan, accounting for 46% of the total and maintaining its dominant position with a growth rate of nearly 7%, leading the industry. Critical illness insurance accumulated premiums of about 450 billion yuan, estimated to account for 45%, showing negative year-on-year growth.
Behind this structural shift lies a dual transformation in channels and customer bases. Traditional property and casualty insurers achieve scale expansion through government and enterprise business, while supplementing individual business via cross-selling with auto insurance. Internet-based P&C insurers focus on traffic operations, creating hit products through rapid iteration. Professional health insurance companies, meanwhile, tie into payment platforms to precisely match customer needs.
In 2025, the decline in offline critical illness insurance sales proved difficult to reverse, while online critical illness insurance products exhibited characteristics of short-term and fixed-term coverage, also adopting the "million-yuan medical" model to promote "million-yuan critical illness" products. Against the backdrop of continuously declining predetermined interest rates, premiums for long-term critical illness insurance have climbed. "Million-yuan critical illness" products with 1-year or 10-year terms, leveraging their low-premium advantage, accurately target young internet user groups.
Nursing care insurance and disability insurance showed a trend of "rushing high then falling back." In 2025, the combined premiums of these two categories exceeded 90 billion yuan, estimated to account for 9%, with a year-on-year growth of about 5%, a significant slowdown compared to 2024. The core reason is that before 2024, increasing-payment nursing care insurance experienced high growth riding the industry's popularity. In 2025, affected by the downward adjustment of predetermined interest rates, sales volume contracted significantly. Simultaneously, professional health insurers and foreign-funded insurers accelerated their布局 between 2024 and 2025, reaching younger customer groups through internet traffic platforms and agency channels, focusing on promoting disability income loss insurance. Product structures shifted from group insurance to individual insurance, with policy terms trending towards medium and short durations.
The resilient growth of commercial health insurance complements the strategic "contraction and focus" of basic medical insurance. Under multiple constraints including an intensifying aging population, upgrades in medical technology, and pressure on fund revenues and expenditures, basic medical insurance is transitioning from "broad coverage, guaranteeing basics" to "guaranteeing the core, ensuring sustainability," actively contracting its coverage boundaries and releasing incremental space for commercial health insurance.
The comprehensive implementation of medical insurance payment method reforms (DRG/DIP) has become a key variable forcing the upgrade of commercial health insurance. Data from the National Healthcare Security Administration shows that in 2025, among 393 coordinated regions nationwide, 191 implemented DRG payment and 200 implemented DIP payment, with Tianjin and Shanghai utilizing both models. This achieved full coverage of coordinated regions and eligible medical institutions, with disease coverage reaching 95% and medical insurance fund coverage reaching 80%. Hospitals face sharply increased cost-control pressures, and the use of drugs and consumables within the medical insurance catalog is strictly limited, causing significant demand for innovative drugs, special drugs, and out-of-hospital drug purchases to spill over from the basic medical insurance system.
In this context, the aforementioned "Health Insurance 2026 Outlook Report" points out that against the backdrop of ongoing medical insurance reform, the product design of commercial medical insurance emphasizes the expansion of medical networks into specialized healthcare and international medical fields, thereby spurring a wave of development in mid-to-high-end medical insurance products. Simultaneously, since 2024, commercial medical insurance has gradually incorporated coverage for out-of-hospital drugs. In the foreseeable future, the demand for coverage of "high-quality medical resources, premium drugs, and advanced medical devices" will remain a core market hotspot. Continuous iteration in expanding medical networks, covering advanced drugs and devices, and optimizing service experience will also be a main theme of industry development.
Recently, New China Life Insurance, China Life Re, Rui Ze Health, and Hui Bao Fu Da jointly launched a group medical insurance product codenamed "988" that covers original research drugs. A major highlight is its drug formulary covering over 2,000 medications for common and chronic diseases, including nearly 300 original research drugs such as first-line treatments like Forxiga, Zithromax, Adalat, Glucophage, and Crestor, covering clinically commonly used drugs in areas like oncology and autoimmune diseases, providing patients with drug choices equivalent to those available in offline hospitals. ZhongAn Insurance's "Zun Xiang e Sheng 2026 Edition" expanded its out-of-hospital drug services, both within and outside core coverage, to ZhongAn's Internet hospital, covering over 380 commonly used drugs, including medications like Oseltamivir for influenza A. Taikang Life's "Million Drug Worry-Free (Celebration Edition) Medical Insurance" increased the out-of-hospital drug coverage limit to 1 million yuan, covering original research drugs, innovative drugs, imported drugs, etc. These cases confirm that the intensity of medical insurance cost control is positively correlated with the market space for commercial health insurance.
Meanwhile, the standardized development of Hui Min Bao (city-based customized commercial health insurance) has further clarified the positioning of commercial health insurance. Based on data from the end of 2024, the number of participants in Hui Min Bao is approximately 180 million, but the growth rate has slowed. Since 2025, regulators have explicitly halted the "low-price volume-driving" model, emphasizing product sustainability and abandoning the extensive practice of "trading loss ratios for market share." Industry insiders indicate that in 2026, Hui Min Bao will iterate and upgrade from its basic form of "low premium, high deductible" towards versions with more comprehensive coverage and better services. In the long term, besides promoting group enrollment, Hui Min Bao could implement mechanisms like renewal discounts and benefits for continuous payment, enhancing user stickiness through measures such as reducing premiums or increasing reimbursement ratios for continuous policyholders. Simultaneously, tiered products could be launched, such as basic and premium versions, setting different coverage scopes, reimbursement ratios, and deductibles based on premium levels, rather than relying solely on age-based risk segmentation, to better meet the protection needs of different population groups.
Breaking through industry involution, the iteration of commercial health insurance products in 2026 will exhibit trends of "differentiation, servitization, and precision." Mere post-event reimbursement has lost its core competitiveness, and the deep integration of "payment + service" has become an industry consensus.
The transformation of million-yuan medical insurance is a typical example of product upgrading. Once centered on "low price, high coverage" as its core selling point, million-yuan medical insurance in 2026 is fully transitioning towards service and differentiated competition. For instance, Ping An Health's recently launched "Ping An e Sheng Bao · Million Medical 2026 Flagship Edition" incorporates more high-quality new medical technologies, drugs, and devices into its coverage, upgrades the coverage limit to 6 million yuan, expands the list of out-of-hospital specific cancer drugs from 212 to 298 types, covering 7 CAR-T therapies and various targeted and innovative drugs, while adding 85 clinically急需 imported drugs for severe cancer. The number of proton/heavy ion hospitals covered has expanded to 11, providing customers with more robust bottom-line protection against major illnesses.
Some joint-venture insurers are leveraging their shareholders' advantages to accelerate the construction of closed-loop health industry chains, further strengthening their integration capabilities within the healthcare ecosystem. For example, Fosun United Health Insurance has integrated thousands of medical resources nationwide through partner institutions, offering a full-chain health ecosystem encompassing "early planning, early prevention, early detection, early treatment, and early rehabilitation." It provides customers with a series of health management services including disease prevention, premium health check-ups, direct access to renowned doctors, and inpatient care. Customers purchasing related products can access benefits like fast-track green channels for medical treatment and arrangements for expert consultations through this health ecosystem. For customers requiring surgery, Fosun United Health's Fu An Kang nursing services not only provide professional care in the hospital but also seamlessly connect with the post-operative rehabilitation services of Fosun's affiliated Jian Jia Rehabilitation Hospital, comprehensively addressing inpatient care and rehabilitation issues for clients.
Meanwhile, JD Alliance Property & Casualty Insurance's "Excellent Global High-End Medical Insurance" not only offers direct billing at over 2,000 public and private hospitals in Greater China but also includes global treatment coverage for severe cancer as a standard feature, breaking geographical limitations and directly connecting with top-tier institutions like Mayo Clinic in the US and Hong Kong Integrated Oncology Centre (HKIOC). It provides comprehensive support from multidisciplinary consultations to overseas medical treatment, meeting the global critical illness diagnosis and treatment needs of high-net-worth individuals.
With the advent of the longevity era, the demand for medical and long-term care is becoming increasingly rigid, creating a window of opportunity for explosive growth in long-term care insurance. In September 2025, the National Financial Regulatory Authority issued the "Guiding Opinions on Promoting the High-Quality Development of Health Insurance," explicitly proposing to "accelerate the development of commercial long-term care insurance and disability income loss insurance," injecting crucial policy momentum into the development of commercial long-term care insurance. The "Health Insurance 2026 Outlook Report" points out that nursing care insurance naturally combines the dual attributes of "longevity + health," making it an important financing tool for addressing population aging. Currently, some insurers in the market are combining commercial nursing care insurance with annuity insurance, using annuities to provide stable cash flow and nursing care insurance to cover care expenses after disability, forming composite solutions. Simultaneously, they are engaging in deep product linkages with retirement communities, proposing the concept of "full life cycle financing" to further complete the eldercare protection closed loop.
Crossing the trillion-yuan threshold signifies that commercial health insurance has moved from the high-growth "golden era" into the mature and professional "silver era." Driven by the multiple factors of medical insurance strategic contraction, population aging, and technological iteration, the industry's growth logic has been completely reconstructed—shifting from "scale and price wars" to "value and service wars," and from "generalized growth" to "precise, segmented growth."
As McKinsey's Ye Hai stated, the core of the resilient growth era is "calculating the accounts clearly, acting with precision, and building barriers." In the future, with the refinement of commercial insurance catalogs, the popularization of managed care, and the deep application of AI technology, commercial health insurance will form efficient synergy with basic medical insurance, jointly reinforcing the essential framework of the multi-tiered medical security system. The gate to the trillion-yuan market is already open, and the new chapter of resilient growth has just begun.
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