University Hlth Care & Gundersen Lut Market Analysis: Market Share and Coverage by State

Payer Overview

University Hlth Care & Gundersen Lut operates as a regional commercial and government lines payer with a focused but meaningful national position. It is the #67 largest US A&H payer by premium and writes $2.31B in the US, representing a 0.16% US market share across 4 states. The organization reports an Estimated Total Members figure of 379.1K and operates through 4 affiliated subsidiaries.

The payer's footprint is concentrated in the Upper Midwest, with its largest state presence driving most of its activity. This concentration shapes contracting leverage and network strategy: provider groups engaging the payer should expect negotiation dynamics driven by strong regional premium and membership density rather than broad national scale. Data indicates the payer does not report a #1 ranking in any state.

Premium by Scope

University Hlth Care & Gundersen Lut's premium is exclusively reported in the US States & DC scope, accounting for 100.00% of its documented premium. There is no separate US territory or foreign premium reported for this payer, indicating an exclusively domestic mainland footprint. For providers, this concentration means contracting and network strategies should focus on the payer's regional operations within the documented states rather than expecting exposure from territories or international business.

University Hlth Care & Gundersen Lut shows a highly concentrated premium footprint, with $2.17B written in WI alone and a national total of $2.31B. The payer's membership base mirrors premium concentration with 359K estimated members in WI out of 379.1K total members. This concentration indicates significant negotiating leverage in Wisconsin and localized network influence, while presence in IL, MN, and IA is comparatively modest.

For provider contracting, the geographic concentration means that system-wide negotiations should prioritize Wisconsin-market terms and capacity planning. Multi-state provider groups should expect materially different commercial dynamics in WI versus IL, MN, and IA, with WI negotiations likely driving most financial outcomes.

State-by-State Market Position

University Hlth Care & Gundersen Lut's strongest presence is in the Midwest, particularly Wisconsin where it holds its top ranked state position and writes $2.17B in premium. The other Midwestern states in its footprint — Minnesota, Illinois, and Iowa — show much smaller premiums ($51.1M, $82.0M, and $4.08M, respectively) and correspondingly lower market shares.

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 and 55–64, each with over 57,000 members, followed closely by the 35–44 and 45–54 bands. The pediatric segment (Under 6 and 6–18) together accounts for over 82,000 members, indicating a strong family and youth presence. The senior segment (65–74 and 75+) is smaller but still significant, with over 54,000 members combined.

Wisconsin dominates the member distribution, with over 358,000 estimated members, far outpacing other states. The age distribution in Wisconsin closely mirrors the national profile, while smaller states like Iowa and Minnesota have proportionally fewer members across all age bands. No state shows a dramatic skew toward older or younger populations, but the overall mix suggests a balanced need for pediatric, adult, and senior care.