Cambia Health Solutions Inc Market Analysis: Market Share and Coverage by State

Payer Overview

Cambia Health Solutions Inc. is the #26 largest US A&H payer by premium, operating across 4 states with a concentrated West regional footprint. The company reports $7.97B in US premium and holds a US market share of 0.55%, with an estimated total membership of 1.35M across its footprint and operations that roll up through 7 affiliated subsidiaries.

Cambia does not hold a #1 statewide position in the national statistics set provided. Its business is focused on a small group of contiguous Western states, which supports concentrated provider networks and regional contracting strategies rather than a broad national network approach.

Premium by Scope

Cambia Health Solutions Inc.'s premium is exclusively reported in the US States & DC scope in the provided data, accounting for 100.00% of the payer's reported premium. There is no reported premium in US territories or foreign jurisdictions in the supplied statistics.

This exclusive U.S. mainland concentration implies that provider groups negotiating with Cambia will be engaging with a payer whose commercial and network strategies are focused on a limited set of states, simplifying multi-state negotiations to a regional scope rather than a national one.

Cambia's premium is highly concentrated in the Pacific Northwest and Intermountain West, with total reported premium of $7.97B across the four states where it operates. The largest premiums are in Washington ($2.98B) and Oregon ($2.73B), while membership totals are concentrated in Washington (504K) and Utah (330K). This concentration supports regional negotiating leverage with major provider systems in those states but limits national bargaining power.

For national payers or large multi-state provider groups, Cambia's footprint suggests focused contracting efforts will be most effective when targeted to the four states where the payer has scale. Providers operating across broader geographies should expect Cambia to be a significant local counterparty in the West but not a dominant national partner.

State-by-State Market Position

Cambia's strongest presence is in the West. The Western region (specifically the Pacific Northwest and Intermountain West) shows the clearest concentration of market share and premium, with Idaho at 14.31% market share, Utah at 11.71%, Oregon at 10.73%, and Washington at . These four states are contiguous and form a geographic cluster that favors regional provider networks and shared management of care pathways.

The Affordable Care Act (ACA) established federally-facilitated health insurance marketplaces ("exchanges") where individuals and small businesses can shop for and enroll in health plans, often with income-based subsidies. Issuers that participate in these marketplaces are required to report enrollment, claims, and denial data to CMS (Centers for Medicare & Medicaid Services) each year.

The sections below cover this payer's ACA marketplace-specific footprint — enrollment, plan portfolio, and claims/denial-rate data. This is a narrower, separate population from the NAIC-based commercial data shown earlier on this page (total premium, market share, and membership across all lines of business): ACA marketplace enrollment is typically a small fraction of a payer's total commercial book, and the two datasets should not be treated as equivalent. CMS claims-transparency reporting has also been inconsistent industry-wide since 2020 — many issuers have little or no data for 2021 onward, so a single reporting year is common and does not necessarily indicate anything about the payer's current ACA presence.

Estimated Member Demographics

Nationally, the largest age bands for CAMBIA HEALTH SOLUTIONS INC are 6–18 (228,456 members), 35–44 (203,631 members), and 26–34 (179,663 members). This indicates a strong presence among families and working-age adults, with a substantial pediatric population. The senior population (65+) is smaller, totaling just over 172,000 members across 65–74 and 75+ bands.

State-level analysis shows Washington has the largest member count across all age bands, followed by Utah, Oregon, and Idaho. Utah and Idaho have relatively higher proportions of younger members (Under 6 and 6–18), while Oregon and Washington have more balanced distributions across age bands. No state skews dramatically older, but Washington and Oregon have higher absolute numbers in the senior bands due to their larger overall member counts.