Carle Holding Co Grp Market Analysis: Market Share and Coverage by State

Payer Overview

Carle Holding Co Grp operates as a regional health insurer with a concentrated but meaningful national presence. The company ranks as the #74 largest US A&H payer and reports $1.98B in US premium, representing a 0.14% US market share across 5 states. The organization reports an Estimated Total Members figure of 289.4K and operates through 5 affiliated subsidiaries, shaping its underwriting and provider contracting approach.

The payer does not hold a #1 position in any US state. Carle Holding Co Grp's premium and membership are highly concentrated in the Midwest, with the largest single-state premium position in Illinois. This concentrated footprint and modest national ranking influence negotiation leverage with national provider groups while offering deeper local relationships in its core states.

Premium by Scope

Carle Holding Co Grp's premium footprint is exclusively within the US states and DC scope as reported. The payer writes $1.98B in US premium, representing the entirety of its reported premium across all scopes. For providers evaluating this payer, the absence of territory or foreign exposure means network negotiations and utilization patterns will be driven by US state dynamics only, with particular attention to the states where the insurer is active.

Carle Holding Co Grp's premium and membership are heavily concentrated in Illinois, which accounts for the vast majority of its premium exposure with $1.72B written there. The remaining states each represent single-digit percentages of premium and collectively amount to less than $300M outside Illinois. This concentration implies the payer has significant local market influence in Illinois while maintaining limited but present footprints in Washington, North Carolina, Iowa, and Indiana.

From a provider contracting perspective, national or multi-state health systems negotiating with Carle Holding Co Grp should focus on Illinois to capture the largest economic opportunity, while state-level strategies in Washington and North Carolina can address regional network access and utilization. Smaller presences in Iowa and Indiana suggest localized agreements rather than systemwide contract terms will be most relevant.

State-by-State Market Position

Carle Holding Co Grp's strongest presence is in the Midwest, anchored by Illinois where it writes $1.72B of premium. The payer's footprint outside the Midwest is modest, with Washington and North Carolina each representing secondary markets at $128M and $97.1M respectively. Iowa and Indiana are minor markets by comparison.

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 are 6–18 (45,024 members), 35–44 (42,305 members), 55–64 (40,948 members), and 45–54 (40,478 members). The pediatric (under 18) and working-age adult (35–64) segments dominate the member profile, while seniors (65+) represent a smaller proportion.

Illinois, the payer's strongest state, mirrors the national distribution, with the largest counts in the 6–18, 35–44, and 55–64 bands. Other states, such as Washington and North Carolina, show similar patterns, though with smaller absolute numbers. No state skews dramatically older or younger, but Illinois' large member base amplifies the national trend toward younger and working-age populations.