FIRST MEDICAL HLTH PLAN INC Market Analysis: Market Share and Coverage by State

Payer Overview

FIRST MEDICAL HLTH PLAN INC operates as a concentrated specialty payer with limited national footprint but meaningful exposure in U.S. territories. Nationally, the organization reports a US market rank of the #0 position among A&H payers, with $0 in US premium and a US market share of 0%, and its reported domestic footprint covers 0 states. The company reports an Estimated Total Members value of N/A and operates through 0 affiliated subsidiaries.

Beyond the continental United States, FIRST MEDICAL HLTH PLAN INC maintains a substantive presence in U.S. territories, writing $1.68B across 1 territory (Puerto Rico). This territorial concentration highlights a payer that is focused outside the 50 states rather than across the contiguous U.S. and signals specialized contracting dynamics in that territory.

Premium by Scope

FIRST MEDICAL HLTH PLAN INC derives its premium entirely from U.S. territories, with $1.68B written in Puerto Rico and no recorded premium in the 50 states + DC. This concentration means the payer’s revenues, network contracting leverage, and care management programs are likely calibrated to territory-specific regulations and provider markets rather than broad national negotiation strategies.

For a provider evaluating this payer, the implication is clear: contracting and reimbursement discussions should be focused on territorial operations and local market dynamics in Puerto Rico rather than national network strategies.

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