Background: There is an increasing rise of cholangiocarcinoma though the cause is unclear. Cholangiocarcinoma is more often than not incurable at diagnosis and associated with a high mortality rate. Our goal was to compare survival of patients with differing insurance types diagnosed with cholangiocarcinoma identified in the National Cancer Database (NCDB). Methods: We identified 5,638 patients with cholangiocarcinoma in the NCDB diagnosed between 2004-2014. Patients included were categorized as having no insurance, private insurance, Medicaid, or Medicare were included. Between-insurance survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Statistically significant survival differences were indicated between all insurance groups (all adjusted p < 0.05), such that privately insured patients had the highest median survival. The discrepancy in survival between uninsured and privately insured patients was the largest (6.5 months vs 13.1 months, respectively). Medicaid patients on average had a survival of 7.5 months, while Medicare patients had a median survival of 7.8 months. 2.8% of uninsured patients presented with stage I cholangiocarcinoma, whereas 34% of privately insured patients presented with stage I cholangiocarcinoma. More Medicare patients were treated at community cancer programs compared to privately insured patients (56.7% vs 30.7%, respectively). Likewise, more Medicare patients were treated at academic/research programs compared to those with private insurance, Medicaid, or those who were uninsured (44.7% vs 38.7% vs 7.2% vs 3.7%, respectively). Conclusions: Our study shows the discrepancies in survival between patients with differing insurance statuses. Of all insurances, those privately insured had the largest median survival.