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    v1.0.28
    OpenPayerStatesIdaho
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    Idaho Health Insurance Market Analysis: Market Share, Payer Mix, and Coverage Trends

    Idaho's health insurance market is dominated by Gemstone Holdings Group, with UnitedHealth Group and Cambia Health Solutions Inc also holding significant positions. The landscape features a mix of national and regional insurers, with a high concentration among the top payers.

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    State Overview

    Idaho has a total population of 1.91M residents. The state comprises 44 counties. The private insurance penetration rate is 68.8%, calculated from the privately insured total of 1.31M out of the total population. The estimated members covered by Gemstone Holdings Group, the top payer, is 454.0K.

    Insurance Market

    RankInsurerPremium WrittenEstimated Members CoveredMarket Share
    1Gemstone Holdings Group$2.23B454.0K34.58%
    2UnitedHealth Group$937.2M191.0K14.56%
    3Cambia Health Solutions Inc$921.0M187.7K14.31%
    4IHC Inc Group$497.6M101.4K7.73%
    5Molina Healthcare Inc Group

    Frequently Asked Questions

    References

    1. 1.S2703: Private Health Insurance Coverage by Type and Selected Characteristics. U.S. Census Bureau, 2024 American Community Survey 5-Year Estimates. Retrieved Aug 11, 2026.Annual estimates of private health insurance coverage rates by state, broken out by age, income, and plan type — the basis for this page's coverage-rate figures.
    2. 2.2024 Market Share Reports for the Top Accident and Health Insurance Groups and Companies by State and Countrywide. National Association of Insurance Commissioners (NAIC). Retrieved Aug 11, 2026.Ranks the largest accident and health insurance carriers by direct premiums written in each state, used to identify the dominant payers operating there.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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    $335.4M
    68.4K
    5.21%
    6PacificSource Health Plan Group$327.0M66.6K5.08%
    7CVS Group$233.9M47.7K3.64%
    8Humana Group$142.5M29.0K2.21%
    9Cigna Health Group$81.0M16.5K1.26%
    10Delta Dental Plan of ID Inc$80.6M16.4K1.25%

    Gemstone Holdings Group is the leading insurer in Idaho, commanding over a third of the market. UnitedHealth Group and Cambia Health Solutions Inc also hold significant shares, making them key players in the state's insurance landscape. The top three insurers collectively cover more than half of Idaho's privately insured population.

    The remaining insurers in the top ten contribute smaller shares, with IHC Inc Group, Molina Healthcare Inc Group, and PacificSource Health Plan Group rounding out the mid-tier. National brands such as CVS Group, Humana Group, and Cigna Health Group are present but have more modest market positions. Delta Dental Plan of Idaho Inc completes the top ten, reflecting the inclusion of dental coverage within the broader insurance market.

    Overall, Idaho's health insurance market is highly concentrated, with the top ten insurers accounting for nearly 90% of the market. This concentration shapes the competitive dynamics and coverage options available to residents.

    Insured Population Demographics

    Coverage TypeCountShare of Privately Insured
    Employer-Based860.2K65.6%
    Direct-Purchase144.1K11.0%
    TRICARE18.4K1.40%
    CHIP/Subsidized48.6K3.70%

    The majority of Idaho's privately insured population is covered through employer-based plans, accounting for nearly two-thirds of all privately insured residents. Direct-purchase coverage represents a smaller but significant portion, while TRICARE and CHIP/subsidized programs cover a modest share of the population.

    Idaho's insured population is distributed across all age bands, with the largest segment in the 6-18 age group. The presence of CHIP/subsidized coverage highlights the importance of public programs for children and lower-income families. The demographic profile suggests a relatively young population, with substantial coverage among working-age adults and families.

    Market Dynamics

    Idaho's health insurance market is characterized by a high degree of concentration among a few dominant payers. Gemstone Holdings Group leads the market with a substantial share, followed by UnitedHealth Group and Cambia Health Solutions Inc. Together, the top three insurers account for over 63% of the market, indicating limited competition among smaller payers.

    The cumulative market share of the top ten insurers exceeds 89%, underscoring the dominance of established national and regional players. This concentration may influence plan offerings, pricing, and network design across the state. The presence of both national brands and regional insurers reflects a blend of local and national market dynamics.

    Demographically, Idaho's privately insured population is primarily covered through employer-based plans, with direct-purchase options and public programs like CHIP and TRICARE playing supporting roles. The age distribution shows a strong presence of children and working-age adults, suggesting a focus on family and employment-driven coverage.

    Overall, Idaho's insurance landscape is shaped by a concentrated payer environment and a demographic profile that emphasizes employer-based coverage and a relatively young population. These factors contribute to the state's unique market structure and coverage patterns.

    Top 10 Health Insurers by Market Share in Idaho
    Privately Insured Population by Age Band in Idaho