Payer Overview

Avera Hlth Plans Inc Market Analysis: Market Share and Coverage by State

Avera Hlth Plans Inc is a regional health insurer with a focused state footprint and modest national premium. Its concentrated membership base drives localized provider contracting dynamics.

Avera Hlth Plans IncHealth InsuranceHealthcare MarketProvider ContractingReimbursementSouth DakotaIowaNebraska

Payer Overview

Avera Hlth Plans Inc occupies a modest position in the national accident & health marketplace as the #135 ranked US A&H payer by premium. Their reported US premium is $287M, representing a US market share of 0.02%, and they operate in 3 states. The company reports an estimated total membership of 69.6K, and it does not operate through any affiliated subsidiaries (operates through 0 affiliated subsidiaries).

Avera Hlth Plans Inc's strongest presence is concentrated regionally rather than nationally, so their premium and membership are focused in a few contiguous states rather than spread across many markets. This concentrated footprint shapes how the payer negotiates with providers and where it can exert leverage on network reimbursement and narrow-network design.

Premium by Scope

Scope	Jurisdictions	Premium	Share of Payer Total
US States & DC	3	$287M	100.00%
Total	3	$287M	100.00%

Avera Hlth Plans Inc's premium footprint is exclusively within the US states and DC scope as reported. The payer reports $287M of premium in the US states & DC scope, representing 100.00% of the payer's total reported premium across all scopes. This concentration implies that provider strategy should focus on US-state contracting channels, with no reported exposure to US territories or foreign markets to consider.

National Market Presence

National Market Footprint

State	Market Share	Premium Written	Estimated Members
IA	0.04%	$6.66M	1.00K
NE	<0.01%	$177K	31
SD	9.51%	$280M	68.6K
National Total	—	$287M	69.6K

Avera Hlth Plans Inc's premium and membership are highly concentrated in the upper Midwest, with $280M of premium and 68.6K estimated members in South Dakota alone. The insurer's presence in Iowa and Nebraska is minimal by comparison, totaling about and respectively in premium. For national-level provider contracting, this concentration suggests negotiations and network design should prioritize South Dakota markets where the payer carries material volume; efforts in Iowa and Nebraska are less likely to move network-wide economics given their relatively small membership and premium contributions.

Age Band	South Dakota	Iowa	Nebraska	National Total
Under 6	4,847	62	2	4,911
6–18	12,061	164	6	12,231
19–25	6,394	104	3	6,501
26–34	8,057	116	4	8,177
35–44	9,449	137

Age Band

South Dakota

Iowa

Nebraska

National Total

Under 6

4,847

4,911

6–18

12,061

164

12,231

19–25

6,394

104

6,501

26–34

8,057

116

8,177

35–44

9,449

137

Estimated Members by State

The vast majority of AVERA HLTH PLANS INC's estimated 69,612 members are located in South Dakota, which accounts for 68,581 members—over 98% of the total. Iowa has an estimated 1,000 members, while Nebraska has a negligible presence with just 31 members. This distribution aligns closely with the payer's market share and premium volume, both of which are overwhelmingly concentrated in South Dakota.

This geographic concentration means that providers in South Dakota are most likely to encounter AVERA HLTH PLANS INC members and should prioritize payer contracting and care management strategies accordingly. In Iowa and Nebraska, the payer's footprint is minimal, and providers may see only a handful of members, making AVERA HLTH PLANS INC a lower priority for contracting and operational focus in those states. For multi-state provider groups, the payer's relevance is almost entirely limited to South Dakota, with little impact elsewhere.

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Payer Overview

Avera Hlth Plans Inc Market Analysis: Market Share and Coverage by State

Payer Overview

Premium by Scope

National Market Presence

National Market Footprint

Estimated Member Demographics

State-by-State Market Position

Estimated Members by State