Mercy Hlth Corp Grp Market Analysis: Market Share and Coverage by State

Payer Overview

Mercy Hlth Corp Grp is a regional health insurance organization positioned within the broader U.S. accident & health market as the #183 ranked US A&H payer by premium. The company reports $149.86M in US premium and holds a 0.01% US market share across 2 states, operating through 2 affiliated subsidiaries and serving an estimated 24.5K members.

The payer's footprint is concentrated in the Midwest, with the largest presence in Wisconsin and a secondary presence in Illinois. Mercy Hlth Corp Grp does not hold a #1 position in any state. Its operations are limited to the U.S. states reported; there is no recorded territory or foreign premium in the authoritative data.

Premium by Scope

Mercy Hlth Corp Grp's premium is exclusively within the US states and DC scope based on the authoritative data. The payer reports $149.86M in US premium, representing 100.00% of its reported premium across all scopes. For providers assessing this payer, the concentration solely in US states implies contractual negotiations and network strategies should focus on domestic regulatory environments and state-level market dynamics.

National Market Footprint

Mercy Hlth Corp Grp's premium is highly concentrated in the Midwest, with $137M written in Wisconsin and $13.2M in Illinois, totaling $149.86M across the reported footprint. The estimated membership aligns with that concentration: about 22.6K members in Wisconsin and 1.91K in Illinois, for 24.5K members nationally. This regional concentration means provider contracting efforts will have the greatest leverage and operational impact in Wisconsin, where the payer carries the bulk of its premium and membership.

For national provider groups considering participation, the payer's limited geographic spread suggests targeted network negotiations in the Midwest rather than broad, multi-region contracting. Volume-based incentives and local market performance metrics will be most relevant in Wisconsin, while Illinois represents a much smaller operational priority.

State-by-State Market Position

Mercy Hlth Corp Grp's strongest presence is in the Midwest region, led by Wisconsin and followed by Illinois. The Midwest concentration indicates that regional provider networks, particularly in Wisconsin, should expect the most significant payer interactions and potential patient volume: $137M of premium and 22.6K members are centered there. Other U.S. regions show no reported presence, so multi-region strategies are less applicable when engaging this payer.

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 for MERCY HLTH CORP GRP are 6–18 (3,883 members), 55–64 (3,724 members), and 35–44 (3,404 members). This indicates a strong presence among families with children and adults approaching retirement age. The under-6 and 75+ bands are the smallest, but still represent a meaningful portion of the membership.

Wisconsin, the dominant state for this payer, closely mirrors the national age distribution, with a slightly higher proportion of members in the 55–64 and 6–18 bands. Illinois, with a much smaller membership base, shows a similar pattern but with a slightly higher relative share in the 26–34 and 35–44 bands. Overall, there is no extreme skew toward either a very young or very old population, but the payer's book is clearly family- and working-age focused.

Estimated Members by State

MERCY HLTH CORP GRP's estimated total membership is 24,494 across two states. The vast majority of members are in Wisconsin (22,582), with a much smaller contingent in (1,912). This distribution aligns with the payer's market share, as Wisconsin is where MERCY HLTH CORP GRP holds a significant market position (0.49 share), while Illinois represents a minor presence (0.02 share).