M MELE GRP Market Analysis: Market Share and Coverage by State

Payer Overview

M MELE GRP occupies a modest position within the national accident & health market as the #237 ranked US A&H payer by premium. The company reports $16.3M in US premium and operates across 2 states, giving it a focused but clearly regional footprint. Estimated Total Members for the organization are 2.1K, and it operates through 2 affiliated subsidiaries.

While M MELE GRP does not hold a #1 position in any state, its concentrated presence in a small number of states can support targeted provider contracting strategies that prioritize depth over breadth. This regional concentration allows the payer to negotiate with multi-hospital systems in specific markets while avoiding the complexities of a nationwide network.

Premium by Scope

M MELE GRP's premium is exclusively within the US States & DC scope, representing 100.00% of its reported premium. There is no reported premium in US territories or foreign jurisdictions for this payer.

This concentration implies that providers evaluating contracts with M MELE GRP should focus on its US state markets, where network depth and local reimbursement terms will matter most. With the entire premium base on the US mainland, national or multi-territory contracting considerations are less relevant for this payer.

M MELE GRP's premium is concentrated in the Northeast, with $10.2M written in NJ and $6.09M in PA, totaling $16.3M nationwide. The estimated member base is 2.1K, with the largest share of members in New Jersey (about 1.42K). This regional concentration suggests negotiation leverage and network focus should be prioritized in the New Jersey market, followed by Pennsylvania.

For national provider groups, the payer's footprint is small but meaningful in targeted hospitals and practices across the Northeast. Providers should evaluate contract terms and referral patterns in NJ first, where the payer has the greatest premium exposure, and then consider replication in PA where scale is smaller.

State-by-State Market Position

M MELE GRP's presence is strongest in the Northeast region, driven by New Jersey and Pennsylvania. New Jersey is the largest state by premium and members, followed by Pennsylvania; both are within the same Census region, which benefits multi-state provider groups that operate throughout the Northeast. The lack of presence in other regions (Midwest, South, West, Southwest) indicates limited national scale.

For multi-state provider systems, the distribution means focused contract negotiations in a compact geographic area can cover the majority of this payer's business. Given the payer's modest overall premium, providers should weigh the administrative effort of separate agreements against the revenue opportunity represented by $16.3M in premium and members.

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 (323 members), 6–18 (322 members), and 45–54 (300 members), indicating a balanced distribution across pre-senior, pediatric, and adult populations. The smallest bands are Under 6 (126 members) and 75+ (130 members), reflecting fewer very young and senior members.

New Jersey skews slightly younger, with higher counts in the pediatric and young adult bands compared to Pennsylvania. Pennsylvania has a relatively higher proportion of members in the 55–64 and 65–74 bands, suggesting a modestly older insured population. This distribution impacts provider service needs, with New Jersey requiring more pediatric and adolescent care, while Pennsylvania may see increased demand for chronic disease management and preventive services for older adults.

Estimated Members by State

M MELE GRP's estimated member distribution is concentrated in New Jersey (1,415 members) and Pennsylvania (699 members), for a national total of . New Jersey accounts for nearly two-thirds of the payer's insured population, aligning with its higher market share and premium volume in the state.