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.

State-by-State Market Position

Medica Group shows its strongest presence in the Midwest and Plains regions. The payer's top states by premium and share are Minnesota, Wisconsin, Nebraska, North Dakota, and South Dakota, all located in the Midwest/Plains corridor. These states combine to represent the vast majority of the carrier's premium and membership, underscoring a regional rather than national footprint.

The Northeast and West show minimal or no presence for Medica Group based on the available state data. For multi-state provider groups, this distribution means negotiating leverage will vary dramatically by market: strong in the Upper Midwest where Medica Group has deep membership and limited in peripheral states where the payer's premium is a small fraction of the market. Providers pursuing value-based contracts should prioritize pilots and integrated partnerships in Minnesota and Wisconsin, then extend successful models into Nebraska, North Dakota, and South Dakota.

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.

Estimated Members by State

MEDICA GRP's estimated member distribution is highly concentrated in the Midwest, with Minnesota (482,844 members) and Wisconsin (331,962 members) accounting for the majority of the insured population. Nebraska (102,811), South Dakota (46,701), and North Dakota (41,481) also have notable member counts, reinforcing the payer's regional strength. States such as Iowa (15,155), Missouri (13,078), and Oklahoma (11,268) have moderate presence, while Arizona, Kansas, Illinois, and Wyoming have relatively small member populations.

This geographic concentration aligns closely with MEDICA GRP's market share rankings, where the payer holds top positions in Minnesota, Wisconsin, and North Dakota. The alignment between member counts and market share suggests that providers in these states are likely to encounter MEDICA GRP members frequently, impacting contracting strategies and care delivery models. In states with lower member counts, the payer's influence is more limited, and provider engagement may be more specialized or focused on niche populations.

For providers, understanding this distribution is critical for resource planning, network development, and population health initiatives. States with high member concentration may require broader service offerings and robust care management programs, while those with fewer members may focus on targeted services or specialty care for specific age bands or conditions.