PACIFICSOURCE HLTH PLAN GRP Market Analysis: Market Share and Coverage by State

Payer Overview

PacificSource Health Plans is the #45 largest US A&H payer by reported premium, with a US premium of $4.03B and a US market share of 0.28%. The organization reports a presence in 4 states and DC is not included in that count, and it covers an estimated 535.1K members across its footprint. PacificSource Health Plans operates through 3 affiliated subsidiaries.

The payer's business is concentrated in the Pacific Northwest and nearby Mountain West, which shapes its provider contracting leverage and network design. Given the concentrated premium base of $4.03B, regional provider groups and health systems in those states will encounter a counterparty with material local scale but limited national reach.

Premium by Scope

PacificSource Health Plans' premium is exclusively within the US States & DC scope as reported; there is no recorded premium in US territories or foreign jurisdictions. This concentration means the payer's risk exposure and contracting priorities are focused on a small set of domestic states. For provider organizations, that implies negotiations and network strategies should prioritize the payer's strong states rather than expecting material leverage or influence in territories or international markets.

PacificSource Health Plans shows heavy concentration in the Pacific West, with the largest premium pool in Oregon at $3.36B. The total premium across reported states is $4.03B, supporting an estimated 535.1K members. This concentration gives the payer meaningful regional negotiating power in Oregon while leaving it more modest in Washington and more moderate in Idaho and Montana.

For national provider networks, the geographic concentration implies that contracting strategies should be tailored: secure favorable terms in Oregon where the payer has scale, and pursue state-specific arrangements or carve-outs in Idaho, Montana, and Washington. Regional health systems that operate across these states may find PacificSource Health Plans an important counterparty in the Pacific Northwest but not a primary national partner.

State-by-State Market Position

PacificSource Health Plans' footprint is strongest in the West. The payer's top position is in Oregon where it posts a 13.2% market share and writes $3.36B in premium, making Oregon the clear center of gravity. Montana and Idaho are secondary markets with 7.39% and 5.08% shares respectively, each representing meaningful but smaller premium pools of and . Washington represents a modest presence at and written.

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, 35–44, and 45–54, each with over 73,000 members. This indicates PACIFICSOURCE HLTH PLAN GRP covers a broad spectrum of ages, with a strong presence among families and working-age adults. The pediatric population (Under 6 and 6–18) is substantial, while the senior population (65–74 and 75+) is also significant, though smaller than the adult cohorts.

State-level analysis shows Oregon has the largest member counts across all age bands, reflecting its dominant market share. Idaho and Montana have similar age distributions, with slightly higher proportions in the adult and senior bands. Washington, with the smallest member count, has a relatively balanced age profile but fewer seniors. No state skews dramatically older or younger, but Oregon's sheer volume amplifies all age groups.

Estimated Members by State

PACIFICSOURCE HLTH PLAN GRP's estimated member distribution is highly concentrated in Oregon, with members, followed by Idaho (), Montana (), and Washington (). This geographic concentration aligns closely with the payer's market share, as Oregon is their strongest state both in share and member count. Idaho and Montana, while smaller in absolute numbers, still represent significant populations for provider contracting.