Payer Overview
Neighborhood Health Plan of RI Inc Market Analysis: Market Share and Coverage by State
Neighborhood Health Plan of RI Inc is a Rhode Island-focused health insurer with a concentrated local footprint. The payer emphasizes state-level network management and contracting given its single-state presence.
Payer Overview
Neighborhood Health Plan of RI Inc operates as a regional health insurer centered in Rhode Island and is the #75 ranked US A&H payer by reported premium. Its US premium footprint is $1.94B, representing a 0.14% US market share and operating across 1 states. The organization reports an estimated total membership of 237K and does not operate through any affiliated subsidiaries.
Neighborhood Health Plan of RI Inc's scale is concentrated in a single state market, which shapes its negotiating leverage with local provider systems and its operational focus on Rhode Island-specific networks and regulatory relationships. This concentrated presence supports targeted network management and payer-provider contracting strategies tailored to the state's care patterns and cost drivers.
National Market Presence
| State | Market Share | Premium Written | Estimated Members |
|---|---|---|---|
| RI | 30.31% | $1.94B | 237K |
| National Total | — | $1.94B | 237K |
Neighborhood concentration is high: $1.94B of premium and 237K estimated members are all concentrated in Rhode Island, indicating the payer's market influence is localized. This single-state dominance means contracting leverage is driven by relationships with Rhode Island health systems and physician groups rather than a dispersed national network. For providers, a concentrated payer like this can offer streamlined negotiations regionally but limits opportunities for multi-state rate harmonization.
Because the payer's footprint is limited to one state, network adequacy, local care delivery patterns, and state regulatory dynamics will disproportionately determine reimbursement outcomes and strategic priorities. Provider contracting teams negotiating with this payer should prioritize Rhode Island market intelligence and relationship-building with the payer's local network management.
Estimated Member Demographics
| Age Band | Rhode Island | National Total |
|---|---|---|
| Under 6 | 13029 | 13029 |
| 6–18 | 33760 | 33760 |
| 19–25 | 25379 | 25379 |
| 26–34 | 29701 | 29701 |
| 35–44 | 33237 | 33237 |
| 45–54 | 31241 | 31241 |
| 55–64 | 36546 | 36546 |
| 65–74 | 20204 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.