CDPHP INC GRP Market Analysis: Market Share and Coverage by State

Payer Overview

CDPHP INC GRP is a nationally ranked health insurer operating as the #55 largest US A&H payer with $2.83B in US premium and a 0.2% US market share. The organization reports a footprint in 1 states, serves an estimated 476K members, and operates through 2 affiliated subsidiaries, reflecting a compact but meaningful regional operator concentrated in New York.

The payer's US premium of $2.83B represents its principal commercial and government book of business; it does not report premium in US territories or foreign markets. That concentrated geographic exposure gives CDPHP INC GRP clear negotiating leverage with provider systems in its primary state while limiting its influence with national multi-state networks.

Premium by Scope

CDPHP INC GRP's premium is exclusively reported in the US states & DC scope, with $2.83B concentrated there and no recorded premium in US territories or foreign markets. This means the payer's underwriting and network strategies are focused on the domestic market only.

For providers, the lack of territory or foreign exposure simplifies contracting considerations: relationship-building and rate negotiations should be prioritized within the payer's US footprint, particularly where the payer concentrates membership.

National Market Footprint

CDPHP INC GRP is highly concentrated in New York, where it writes $2.83B in premium and covers 476K members. This single-state concentration means the payer's market influence is intense within New York but limited nationally, so provider networks negotiating in New York should treat CDPHP INC GRP as a significant local counterparty.

Nationally, the payer's presence does not span multiple states, which reduces complexity for multi-state provider groups but also limits opportunities for regional scale agreements. Systems operating only in New York will find the most strategic value in contracting with this payer.

State-by-State Market Position

CDPHP INC GRP's footprint is essentially regional, focused in the Northeast with its sole reported presence in New York. The concentration in a single state suggests that the payer's strongest negotiating leverage and network design expertise are local rather than multi-regional. For multi-state provider groups seeking broad contracting reach, CDPHP INC GRP offers limited value beyond New York, but for health systems with substantial operations in New York the payer represents a meaningful revenue source.

Given the payer's concentrated profile, provider contracting strategies should prioritize New York market dynamics; statewide initiatives, reimbursement models, and narrow-network arrangements will have outsized impact on the payer's membership and network performance. Systems should model utilization and revenue risk using the 476K member base and the $2.83B premium to evaluate the commercial importance of agreements with CDPHP INC GRP.

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

The largest age bands nationally are 55–64 (70,126 members), 35–44 (66,218 members), and 45–54 (64,841 members), indicating a strong presence among working-age and pre-retirement adults. The pediatric population (Under 6 and 6–18) is also substantial, with over 96,000 members combined, while the senior population (65+) is smaller but still significant.

New York, the only state with reported member estimates, mirrors the national profile exactly, as all CDPHP INC GRP members are concentrated here. There is no notable skew toward older or younger populations in the available data; the distribution is balanced across age bands, with a slight emphasis on adults and pre-retirement members.

Estimated Members by State

CDPHP INC GRP's estimated member count is 476,021, all concentrated in New York. This aligns with the payer's market share and premium volume, as New York is the only state with a significant presence and reported member estimates. The other reported regions ('States, U.S. Territories, Canada, Aggregate Other Alien' and 'States and U.S. Territories') do not have distinct member counts and are likely administrative or aggregate categories.

This geographic concentration means that providers in New York are the primary audience for CDPHP INC GRP's insured population. The alignment between market share, premium, and member count in New York underscores the payer's regional focus. For providers outside New York, CDPHP INC GRP is not a significant contracting target, but within New York, their member base represents a substantial opportunity for network participation and care delivery partnerships.