Neighborhood Health Plan of RI Inc Market Analysis: Market Share and Coverage by State

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.

Premium by Scope

Neighborhood Health Plan of RI Inc's premium is exclusively concentrated in the US States & DC scope, with $1.94B reported in that category and no recorded premium in US territories or foreign jurisdictions. This concentration implies the payer's revenue and commercial focus are fully domestic and largely state-centric, simplifying regulatory and network considerations for providers negotiating in Rhode Island.

For providers, the exclusive US mainland footprint means reimbursement exposure and contractual opportunities will be localized; multi-state provider groups should treat this payer as a Rhode Island-specific counterparty rather than a multi-jurisdictional partner.

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.

State-by-State Market Position

Neighborhood Health Plan of RI Inc's presence is entirely in the Northeast region via Rhode Island, where it holds its strongest and only market position. The concentration in a single state means there are no distributed regional strongholds across the Midwest, Southeast, West, or Southwest to evaluate.

Top-ranked status is not held in any other state; Rhode Island is the payer's focal point. For multi-state provider groups, the distribution implies limited negotiating portability — contracts and rate schedules negotiated with Neighborhood Health Plan of RI Inc will be relevant primarily within Rhode Island rather than across multiple states.

This geography suggests provider strategy should emphasize local network participation, state-level reimbursement benchmarking, and collaborations with Rhode Island health systems to optimize contracting outcomes.

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

The largest age bands nationally are 6–18 (33,760 members), 35–44 (33,237 members), and 55–64 (36,546 members). This indicates a strong presence among families and working-age adults, with a notable senior population as well. The distribution is relatively balanced, with no single age band dominating the member profile.

Rhode Island, the payer's primary market, mirrors the national demographic profile exactly, as all estimated members are concentrated in this state. There is no evidence of a skew toward older or younger populations in Rhode Island compared to the national total, given the identical figures.

Estimated Members by State

NEIGHBORHOOD HLTH PLAN OF RI INC operates almost exclusively in Rhode Island, with an estimated 237,040 members in the state. This aligns with the payer's high market share and premium volume in Rhode Island, where it holds a 30.31% market share and ranks #2 in the state. No other states report significant member counts for this payer, as all national member estimates are attributed to Rhode Island.

This geographic concentration means that providers in Rhode Island are most impacted by NEIGHBORHOOD HLTH PLAN OF RI INC's contracting and reimbursement strategies. For providers outside Rhode Island, the payer's influence is negligible. The alignment between member count and market share underscores the payer's regional focus and importance for local provider networks.