Payer Overview
Emblem Health Group Market Analysis: Market Share and Coverage by State
Emblem Health Group is a regionally focused health insurer with concentrated strength in the Northeast, serving over one million members through several affiliated subsidiaries. Its market footprint is important for regional provider contracting but limited at the national level.
Payer Overview
Emblem Health Group operates as a mid-ranked national health insurer, positioned as the #30 largest US A&H payer by reported premium. Its US premium footprint is $6.81B, representing a 0.47% US market share and a presence spanning 3 states. The organization reports an Estimated Total Members count of 1.19M and operates through 7 affiliated subsidiaries, reflecting a regional yet strategically concentrated membership base.
The payer's strength is concentrated in the Northeast, with its largest premium contributions and market share driven by a limited number of states. This concentrated geography shapes its contracting posture: network-negotiation leverage will be strongest in its core states where local market share is highest, while national provider groups should view Emblem Health Group as a regionally important counterparty rather than a national-scale payer.
7 rows
| Subsidiary | Domicile |
|---|---|
| Connecticare Benefits Inc | CT |
| Connecticare Inc | CT |
| Connecticare Insurance Company Inc | CT |
| Connecticare of Massachusetts Inc | MA |
| Emblemhealth Insurance Company | NY |
| Emblemhealth Plan Inc | NY |
| Health Insurance Plan of Greater of New York | NY |
National Market Presence
Payer State Presence
| State | Market Share | Premium Written | Estimated Members |
|---|---|---|---|
| CT | 11.27% | $1.52B | 891K |
| MA | <0.01% | $1.04M | 161 |
| NY | 6.44% | $5.29B | 295K |
| National Total | — | $6.81B | 1.19M |
Emblem Health Group's premium and membership are heavily concentrated in a small set of Northeastern states. The carrier writes in premium across the reported states and serves members, with the vast majority of premium tied to New York and Connecticut. This concentration means providers operating in NY and CT will see the most significant encounter volume and payment exposure from Emblem Health Group, whereas national-scale providers should not expect meaningful volume outside these core markets.
Estimated Member Demographics
| Age Band | Connecticut | Massachusetts | New York | National Total |
|---|---|---|---|---|
| Under 6 | 16613 | 9 | 52361 | 68982 |
| 6–18 | 44280 | 23 | 128403 | 172706 |
| 19–25 | 28092 | 17 | 84074 | 112183 |
| 26–34 | 33957 | 21 | 118288 | 152266 |
| 35–44 | 40009 | 22 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.