Payer Overview
Fallon Group Market Analysis: Market Share and Coverage by State
Fallon Group is a regional health insurer focused on a concentrated state footprint with targeted provider relationships. The payer competes nationally at a modest scale while maintaining strong local market ties.
Payer Overview
Fallon Group operates as a regional health insurer with a focused footprint and a measurable national position. As the #77 largest US A&H payer by premium, Fallon Group reports $1.73B in US premium and holds a 0.12% US market share, competing primarily within a concentrated geographic footprint of 1 states. The company reports an Estimated Total Members count of 266K and operates through 2 affiliated subsidiaries.
Fallon Group does not hold a #1 ranking in any state. Its concentration in a single state emphasizes localized product strength and targeted provider relationships rather than broad national network scale.
2 rows
| Subsidiary | Domicile |
|---|---|
| Fallon Community Health Plan Inc | MA |
| Fallon Health & Life Assurance Company | MA |
National Market Presence
National Market Footprint
| State | Market Share | Premium Written | Estimated Members |
|---|---|---|---|
| MA | 4.92% | $1.73B | 266K |
| National Total | — | $1.73B | 266K |
Fallon Group's business is highly concentrated in Massachusetts, with $1.73B of premium written and 266K estimated members located there. This single-state concentration creates strong local bargaining power with providers in Massachusetts but limits leverage in national contracting discussions. For multi-state health systems, Fallon Group represents a deep, localized opportunity rather than a multi-jurisdictional revenue stream.
The concentration also means payer-provider dynamics, utilization patterns, and reimbursement negotiation will be driven by Massachusetts market forces. Systems seeking to negotiate with Fallon Group should prioritize strategic relationships and performance metrics relevant to Massachusetts care delivery standards.
Estimated Member Demographics
| Age Band | Massachusetts | National Total |
|---|---|---|
| Under 6 | 14728 | 14728 |
| 6–18 | 38396 | 38396 |
| 19–25 | 27721 | 27721 |
| 26–34 | 34783 | 34783 |
| 35–44 | 36511 | 36511 |
| 45–54 | 35945 | 35945 |
| 55–64 | 38907 | 38907 |
| 65–74 | 22873 |
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