Payer Overview
Clover Health Group Market Analysis: Market Share and Coverage by State
Clover Health Group is a regional-focused health insurer with a concentrated presence in a small set of states. Its scale supports targeted provider partnerships and selective market strategies rather than broad national contracting.
Payer Overview
Clover Health Group occupies a modest but distinct position in the US accident & health market as the #84 largest US A&H payer by reported premium, writing $1.34B in the US. The company reports a US market share of 0.09% and operates across 4 states, serving an estimated 188.7K members through its operations and affiliated entities. Clover Health Group does not hold a #1 position in any state and operates through 2 affiliated subsidiaries.
Clover Health Group's footprint is concentrated in a handful of states rather than evenly distributed nationwide, which shapes both competitive dynamics and contracting leverage. The firm's premium base of $1.34B in the US suggests focused regional relationships with providers that are especially important for network adequacy and value-based arrangements.
2 rows
| Subsidiary | Domicile |
|---|---|
| Clover HMO of New Jersey Inc | NJ |
| Clover Insurance Company | NJ |
National Market Presence
National Market Footprint
| State | Market Share | Premium Written | Estimated Members |
|---|---|---|---|
| GA | 0.19% | $85.1M | 14.2K |
| NJ | 2.52% | $1.24B | 171.7K |
| PA | 0.01% | $7.59M | 0.87K |
| SC | 0.05% | $12.2M | 1.94K |
| National Total | — | $1.34B | 188.7K |
Clover Health Group's national premium is concentrated in the Northeast, with $1.24B written in New Jersey alone, representing the clear focal point of its footprint. The total reported premium across the included states is $1.34B, and the estimated membership total is 188.7K, indicating a concentrated member base that drives most premium in a single state. For provider contracting, this concentration means negotiating leverage and network design will be most impactful when focused on the New Jersey market, while maintaining competitive networks in Georgia, South Carolina, and Pennsylvania to support limited but strategic membership pockets.
Geographic concentration into one dominant state increases the importance of local market dynamics, state-level regulations, and relationships with major health systems. National provider groups should prioritize contracting efforts where Clover Health Group has scale (notably New Jersey) and consider more targeted, limited arrangements in the smaller footprint states to cover members without overextending network commitments.
State-by-State Market Position
Clover Health Group's presence is strongest in the Northeast, led by New Jersey where it writes $1.24B in premium and holds 2.52% market share. The Southeast shows secondary presence with $85.1M in Georgia and smaller positions in South Carolina ($12.2M) and Pennsylvania ($7.59M). The concentration in New Jersey suggests the payer's competitive activity and provider contracting focus are predominantly regional rather than national.
For multi-state provider groups, Clover Health Group's distribution implies that a deep, high-value agreement in New Jersey will capture the majority of the payer's membership and premium exposure, while lighter-touch arrangements or selective participation may be appropriate in Georgia, South Carolina, and Pennsylvania. The payer's limited state footprint reduces complexity for nationwide contracting but increases the strategic importance of localized relationship management and performance guarantees in its core markets.
Estimated Member Demographics
| Age Band | New Jersey | Georgia | South Carolina | Pennsylvania | National Total |
|---|---|---|---|---|---|
| Under 6 | 10635 | 826 | 103 | 48 | 11612 |
| 6–18 | 26717 | 2239 | 272 | 127 | 29355 |
| 19–25 | 14544 | 1361 | 176 | 81 | 16162 |
| 26–34 | 20512 | 1800 | 232 | 105 | 22649 |
| 35–44 | 24394 | 2100 | 267 | 119 | 26880 |
| 45–54 | 24960 | 2148 | 273 | 117 | 27498 |
| 55–64 | 26379 | 2010 | 295 | 132 | 28816 |
| 65–74 | 13711 | 1012 | 188 | 81 | 14993 |
| 75+ | 9835 | 668 | 129 | 61 | 10694 |
Nationally, the largest age bands among CLOVER HLTH GRP members are 6–18 (29,355), 55–64 (28,816), and 45–54 (27,498), indicating a strong presence in both pediatric and older adult populations. The smallest segments are the senior bands (65–74, 75+) and the youngest (Under 6), suggesting a focus on working-age and pre-senior adults.
State-level analysis shows New Jersey dominates in every age band, reflecting its outsized share of total members. Georgia has the next largest counts, with South Carolina and Pennsylvania trailing. No state skews dramatically older or younger, but New Jersey's sheer volume means its age distribution closely mirrors the national profile.
Estimated Members by State
CLOVER HLTH GRP's estimated member distribution is highly concentrated in New Jersey, with 171,688 members, accounting for the vast majority of the payer's national membership. Georgia follows with 14,165 members, while South Carolina and Pennsylvania have much smaller populations at 1,935 and 871 respectively. This geographic concentration aligns with the payer's premium volume and market share, as New Jersey is also the state with the highest market share and premium written.
The alignment between member counts and market share rank is clear: New Jersey is the primary market, both in terms of premium and membership. Georgia, while a distant second, still represents a meaningful population for providers. South Carolina and Pennsylvania are minor markets, with limited member impact. For providers, this means that contracting and care delivery strategies should be most robust in New Jersey, with tailored approaches for Georgia and minimal focus required for the other states. Multi-state provider groups will find the greatest opportunity in New Jersey, with only niche relevance elsewhere.