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 $227M and $327M. Washington represents a modest presence at 0.34% and $115M written.

This geographic distribution — concentrated in the West and Mountain West — means multi-state provider groups with operations in these regions should prioritize negotiation resources around Oregon and then address state-level network adequacy in Idaho and Montana. For providers pursuing scale, aligning contracting and care management initiatives to the payer's Western footprint will capture the majority of PacificSource Health Plans' membership and premium.

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 386,530 members, followed by Idaho (70,338), Montana (58,765), and Washington (19,435). 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.

The alignment between market share and member count is clear: states with higher market share also have higher member counts. Oregon's dominance means providers in this state will encounter PACIFICSOURCE members frequently, impacting care delivery and reimbursement strategies. In Idaho and Montana, the payer remains a major player, while Washington's smaller member base suggests a more limited impact. Providers should prioritize contracting and care models in Oregon, with tailored approaches for Idaho and Montana based on local member demographics.