Medica Group Market Analysis: Market Share and Coverage by State

Payer Overview

Medica Group operates as a focused regional insurer with a concentrated footprint across the Upper Midwest. The company is the #32 largest US A&H payer by premium and writes $6.36B in the US market, representing a 0.44% US market share across 12 states. The carrier serves an estimated 1.05M members and operates through 8 affiliated subsidiaries, reflecting a compact but deep-market approach in its core states.

Medica Group does not hold a #1 statewide ranking in any state. Its business is concentrated in the Midwest and adjacent Plains states, which supports strong local provider relationships and negotiating leverage in those markets while limiting exposure outside the continental US.

Premium by Scope

Medica Group's premium footprint is exclusively in the US states and DC scope with $6.36B of premium reported there, accounting for 100.00% of the payer's total premium. There is no reported premium in US territories or foreign jurisdictions, indicating the company's operations and risk exposure are fully domestic within the 12 reporting states.

For providers, this concentration means contracting and network strategies should prioritize engagement in those core states where Medica Group writes premium, rather than expecting negotiation leverage or network considerations from territory or foreign exposures.

Medica Group's premium and membership are heavily concentrated in the Upper Midwest, with $3.09B in Minnesota and $2.01B in Wisconsin alone. This concentration drives localized negotiating power with health systems and can simplify network management compared with national carriers. Nationally, the payer's presence is limited; outside its core Midwest footprint premium drops to mid- and low-double-digit millions, which suggests limited scale in those states for broad network leverage.

For provider contracting, focus on Minnesota, Wisconsin, Nebraska, North Dakota, and South Dakota where the payer's scale is material. In those states Medica Group's membership pools (e.g., 482.84K in MN, 331.96K in WI) justify more strategic partnerships and value-based arrangements, whereas in states with single-digit millions of premium and very small membership counts, providers should expect standard commercial negotiation dynamics.

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 (150,059 members), 35–44 (148,397 members), and 6–18 (173,926 members). The pediatric population (under 18) is substantial, while the senior population (65+) is also significant, especially in Minnesota and Wisconsin. States like Minnesota and Wisconsin have the highest member counts, with Minnesota alone accounting for nearly half a million members.

Some states, such as Nebraska and South Dakota, show a balanced age distribution, while smaller states like Wyoming and Illinois have minimal member counts. The overall profile suggests a broad age mix, with a slight skew toward working-age adults and families. Providers should note the diversity in age bands, which impacts care delivery and resource allocation.