WISCONSIN PHYSICIANS SERV INS GRP Market Analysis: Market Share and Coverage by State

Payer Overview

Wisconsin Physicians Serv Ins Grp ranks as the #128 largest US A&H payer by premium and reports $352.73M in US premium, representing a 0.02% US market share across 5 states. The organization operates through 3 affiliated subsidiaries and serves an estimated 57.6K members overall, with its core franchise concentrated in the Midwest.

The company's footprint is focused on Wisconsin while maintaining smaller presences in Illinois, Florida, Michigan, and Ohio. This concentrated geography means that national commercial strategies are anchored by a strong state-level position in Wisconsin even as the payer remains a modest-sized national participant.

Premium by Scope

The payer's premium is exclusively within the US states and DC scope as reported, with $352.73M concentrated in that category. There is no reported premium in US territories or foreign jurisdictions, so the company's market exposure is fully onshore.

For providers evaluating this payer, the concentration in US states implies negotiations and network strategies should focus on state-level dynamics — particularly Wisconsin — rather than international or territory considerations.

The payer's national footprint is highly concentrated in Wisconsin, where it writes $333.71M in premium and covers 55.2K members. Outside Wisconsin the combined premium is modest at roughly $19.02M, spread across Florida, Illinois, Michigan, and Ohio. For national network strategies, this concentration suggests Wisconsin-focused contracting will move the needle most for the payer's revenue and membership base.

Given the 57.6K estimated total members and the strong Wisconsin dominance, providers negotiating with Wisconsin Physicians Serv Ins Grp should prioritize agreements and performance metrics that reflect Wisconsin market dynamics. Expansion opportunities exist in the smaller state markets but will have limited immediate impact on the payer's aggregate scale.

State-by-State Market Position

Wisconsin is the clear center of gravity for this payer, representing the only meaningful market position and the sole top-tier ranking. The Midwest shows the strongest presence due to this Wisconsin concentration, while the Northeast, West, and Southwest show no material footprint. The Southeast has a light presence via Florida, but it is comparatively minor.

Top-ranked performance is singularly in Wisconsin, which drives most premium and membership. For multi-state provider groups, this distribution means contracting and operational focus should be Midwest-centric with targeted, lower-effort engagement in Florida, Illinois, Michigan, and Ohio. National negotiations will have limited leverage unless Wisconsin terms are prioritized.

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 (9,115 members), 55–64 (8,800 members), and 35–44 (7,981 members). Wisconsin, the payer's dominant state, mirrors this distribution, with the highest counts in these age bands. The senior population (65–74 and 75+) is notably smaller, both nationally and in each state.

Florida and Illinois show slightly higher proportions in the older age bands relative to their total members, but overall, the member base is concentrated in children and working-age adults. Michigan and Ohio have very small member counts, with no significant skew toward any age band.

Estimated Members by State