Medical Associates GRP Market Analysis: Market Share and Coverage by State

Payer Overview

Medical Associates GRP is the #189 largest US A&H payer by reported premium, operating with a US premium of $130.31M and a US market share of 0.01%. The company reports a presence across 3 states, and serves an estimated total membership of 20K, operating through 2 affiliated subsidiaries. The payer does not hold a #1 position in any state.

Medical Associates GRP's national footprint is concentrated in a small set of Midwestern states, and its scale positions it as a regional player rather than a national aggregator. This configuration affects negotiating leverage with large multi-state provider systems and favors localized network strategies tied to the company's core states.

Premium by Scope

Medical Associates GRP's premium is entirely within the US States & DC scope, representing the full $130.31M of reported premium. This concentration implies the payer's operational and contractual focus is domestic and tied to its small group of states. For providers, the lack of territorial or foreign exposure means negotiations and network design can be organized around US regulatory and reimbursement norms without additional territorial complexity.

Medical Associates GRP shows a heavy concentration in the Midwest, with $82.5M of premium in IA and a combined Midwest premium of $130.31M across the three states. That concentration suggests contracting leverage is strongest in Iowa where the payer has its largest premium presence and membership base. Providers operating regionally should prioritize network negotiations and credentialing efforts in IA to maximize access to the payer's members.

The payer's limited geographic footprint (3 states) reduces complexity for regionally focused provider groups but limits opportunities for national scale. Multi-state provider systems with ambitions beyond the Midwest will find limited exposure to this payer outside IA, WI, and IL, which may affect the value of pursuing systemwide contract terms with Medical Associates GRP.

State-by-State Market Position

Medical Associates GRP's strongest presence is in the Midwest, led by Iowa. The payer's top states are concentrated in a single Census region, which means its competitive dynamics are primarily shaped by regional market conditions rather than national trends. For multi-state provider groups, the distribution indicates that a focused Midwest contracting strategy will capture most of the payer's membership.

Because the payer's premium and membership are concentrated in a small number of contiguous states, care network design, referral patterns, and utilization management can be coordinated regionally to align with the payer's footprint. Providers should expect the most impactful negotiations and referrals to occur in IA, with secondary considerations in WI and IL.

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 6–18 (3,243 members) and 55–64 (2,878 members), followed by 35–44 (2,770 members). This indicates a strong presence among both pediatric and pre-retirement populations. Iowa, the state with the highest member count, mirrors this distribution, with substantial numbers in both younger and older age bands. Wisconsin and Illinois show similar patterns, though Illinois has a smaller overall member base.

There is no significant skew toward older or younger populations in any single state, but Iowa's larger member base amplifies the impact of its age distribution. Providers should note the balanced mix of children, working-age adults, and seniors, with a slight emphasis on pediatric and pre-retirement care needs.

Estimated Members by State

MEDICAL ASSOCIATES GRP's estimated member distribution is heavily concentrated in Iowa (12,385 members), followed by and . This geographic concentration aligns with the payer's market share, as Iowa is the only state where MEDICAL ASSOCIATES GRP holds a significant market position (), while Wisconsin and Illinois have much smaller shares and member counts.