COMMONWEALTH CARE ALIANCE GRP Market Analysis: Market Share and Coverage by State

Payer Overview

Commonwealth Care Alliance is a focused health insurer with a concentrated footprint and a clear national ranking among accident & health payers. It is the #192 ranked US A&H payer by premium, reporting $106.42M in US premium and a US market share of 0.01%, and it operates across 3 states. The organization serves an estimated 15.7K members and operates through 3 affiliated subsidiaries, reflecting a compact but regionally meaningful presence.

The payer does not hold a #1 position in any state. Its business is concentrated in a small set of states in the Northeast and the Midwest, which shapes contracting leverage locally while limiting national negotiating scale. There is no reported premium in US territories or foreign jurisdictions for this payer, keeping its exposure focused on the US mainland.

Premium by Scope

Commonwealth Care Alliance's premium is exclusively reported in the US States & DC scope, totaling $106.42M, which represents 100.00% of the payer's reported premium. There is no reported premium in US territories or foreign jurisdictions. This concentration implies that provider contracting and network strategy should be focused on the US states where the payer operates, rather than on territorial or international markets.

National Market Footprint

Commonwealth Care Alliance shows strong concentration in the Northeast and a modest presence in the Midwest. The bulk of premium is in Massachusetts at $74.4M, followed by Rhode Island at $17.4M and Michigan at $14.6M, with a national estimated membership of 15.7K. This geographic concentration indicates that provider contracting leverage will be most relevant in Massachusetts and Rhode Island, where local network participation and reimbursement arrangements will affect the largest share of this payer's business.

For providers considering partnerships, the payer's compact footprint means negotiations can be highly regional. Multi-state provider groups should prioritize negotiations in Massachusetts to capture the largest premium exposure, while tailoring approaches in Rhode Island and Michigan where scale is smaller but still material.

State-by-State Market Position

Commonwealth Care Alliance's presence is strongest in the Northeast, led by Massachusetts and Rhode Island, reflecting focused market development in that region. Massachusetts is the clear priority with $74.4M in premium, while Rhode Island contributes $17.4M. The Midwest placement in Michigan at $14.6M represents a geographically separate but smaller footprint.

This distribution suggests the payer offers concentrated regional influence rather than broad national reach. For multi-state provider groups, the payer's distribution favors targeted contracting in the Northeast to access meaningful volume, while arrangements in the Midwest will likely be negotiated at a more localized scale. The absence of activity in other regions reduces complexity for nationwide network strategies but limits leverage for national rate negotiations.

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 55–64 (2,310 members), 6–18 (2,273 members), and 35–44 (2,138 members). This indicates a balanced mix of pediatric, working-age adult, and pre-retirement populations. Massachusetts, with the highest member count, mirrors this distribution, while Rhode Island and Michigan have smaller but similarly structured age profiles.

No state skews dramatically older or younger, but Massachusetts has a slightly higher proportion of members in the 6–18 and 55–64 bands, reflecting its larger overall population. Providers should expect a broad range of care needs, with a focus on both pediatric and adult services.

Estimated Members by State

COMMONWEALTH CARE ALIANCE GRP's estimated member distribution is heavily concentrated in Massachusetts (11,456 members), followed by Rhode Island (2,132 members) and . This geographic concentration aligns with the payer's premium volume and market share, with Massachusetts representing the largest footprint both in terms of premium written and member count.