Providence Health Plan

What Providence Health Plan does

Providence Health Plan is a nonprofit health insurance organization founded in 1984 and headquartered in Portland, Oregon, operating as a wholly-owned subsidiary of Providence Health & Services. The company serves approximately 440,000–660,000 members across Oregon, Washington, California, and Montana, holding the position of third-largest health insurer in Oregon. Its product portfolio spans Medicare Advantage and Medicare Supplement plans, Individual & Family plans (including ACA marketplace offerings), Employer Group/Commercial plans (small group, large group, association, and self-funded ASO), and Medicaid administration through Health Share of Providence OHP.

The operating platform rests on the myProvidence member portal (benefits management, claims history, cost estimators, secure messaging) and the ProvLink provider portal (claims submission, prior authorization, network management), complemented by the internally developed Behavioral Health Concierge program. Distribution combines direct sales (Employer Hub, call centers), a producer/broker portal, ACA marketplace enrollment, and a Collective Health-powered TPA channel for self-funded employers introduced in April 2025. Revenue is generated primarily through recurring health insurance premiums across Medicare Advantage, Individual & Family, and commercial group lines, supplemented by managed-services fees for Medicaid administration and ASO engagements.

Following losses exceeding $100 million in the insurance division in 2025 and four consecutive years without an annual profit, Providence Health & Services announced in March 2026 that it is seeking a buyer for Providence Health Plan and in May 2026 disclosed a planned exit from Individual & Family, Employer Group/Commercial, Medicaid, and ACA lines beginning in 2027, affecting up to 660,000 members. Medicare Advantage operations are slated to continue via a partnership with a national carrier, contingent on a 4-Star CMS rating earned for 2026.

Name

Providence Health Plan

Legal name

Providence Health Plan, Providence Plan Partners, and Providence Health Assurance

Website

https://providencehealthplan.com

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Providence Health Plan is a nonprofit health insurer serving approximately 440,000–660,000 members in Oregon, Washington, California, and Montana with Medicare, Individual & Family, Employer Group, and Medicaid plans, currently winding down most lines by 2027.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)

akta.pro secondary industries

Group HMO Plans (FSAIAFAK), Small Group Health Insurance (2–50/100) (FSAIAFAD), Association & PEO Group Health Plans (AHP/PEO-Sponsored) (FSAIAFAH), Self-Funded Employer POS (ASO/TPA-Administered) (HLAEAOAH)

Keywords

• Health insurance plans
• Medicare Advantage
• Employer group benefits
• Medicaid administration
• Self-funded ASO

Headquarters

HQ city

Eugene

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Health Insurance Premiums: Providence Health Plan generates revenue primarily through collecting premiums from insured members across Medicare Advantage, Individual & Family plans, and employer group commercial plans. The company lost more than $100 million in its insurance division in 2025.
2. Medicare Advantage: Government-sponsored Medicare Advantage plans providing health coverage for seniors, including Medicare Advantage plans that received 4-star CMS rating for 2026.
3. Medicaid Administration: Administration of Oregon Health Plan (Medicaid) coverage for eligible members, with plans to transfer Medicaid program management to another organization.
4. ASO (Administrative Services Only): Self-funded employer plans where Providence provides administrative services rather than insurance, in partnership with Collective Health for technology platform.

Go-to-market motion3 records

Distribution channels5 records

Marketing channels6 records

Core offering

Providence Health Plan is a nonprofit regional health insurance company that underwrites and administers Medicare Advantage and Supplement plans, Individual & Family ACA plans, small and large Employer Group/Commercial plans, Association Health Plans, Self-Funded ASO plans, and Medicaid (Oregon Health Plan) coverage for members across Oregon, Washington, California, and Montana. It distributes these products through employer portals, a producer/broker network, the ACA Marketplace, direct-to-consumer phone/web enrollment, and a Collective Health-powered TPA platform for self-funded employers.

Product overview

Providence Health Plan is a health insurance organization offering a comprehensive portfolio of health coverage products across multiple segments. The core offerings include Medicare Advantage and Medicare Supplement plans for seniors, Individual and Family plans (including ACA marketplace coverage), and Employer Group/Commercial plans for businesses of all sizes. Providence Health Assurance serves as a sub-brand for HMO and Medicaid products. Additional offerings include Association Health Plans and Self-Funded ASO plans for large employers. The organization also provides digital platforms including the myProvidence member portal and ProvLink provider portal. The company has announced plans to exit most insurance business by 2027, focusing on maintaining Medicare Advantage operations through partnerships while seeking buyers for Medicaid programs.

Differentiator

Problem solved

Functional benefit

Brands

• myProvidence: Member portal platform for health plan management
• Providence Health Assurance

Products and services

• Medicare Advantage Plans Hospital, medical, and prescription drug coverage for Medicare beneficiaries through Medicare-approved private insurer plans, including D-SNP options for those eligible for both Medicare and Medicaid. The 2026 plans received a 4-Star CMS rating.
• Medicare Supplement Plans Supplemental insurance policies designed to cover costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
• Individual & Family Plans Health insurance coverage for individuals and families, including ACA marketplace plans and off-exchange options.
• Employer Group/Commercial Plans Health insurance products for employers ranging from small businesses (1–50 employees) to large corporations (51+ employees), including fully-insured and Administrative Services Only (ASO) options.
• Association Health Plans Health coverage options designed for trade groups, professional associations, and business coalitions to provide affordable coverage to member businesses.
• Self-Funded ASO Plans (Collective Health Partnership) Administrative Services Only plans for large employers who prefer to self-fund their employee health benefits while using Providence's provider network and Collective Health's TPA technology platform for benefits management, transparency, and cost efficiency. Projected to reduce healthcare cost trends by 50% over five years.
• Medicaid/Oregon Health Plan State-managed health coverage program for low-income individuals and families, administered through Health Share of Providence OHP.

Quantifiable outcome

• 60% of behavioral health members connected within seven days through Behavioral Health Concierge
• +2 more outcomes

Named customers1 record

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Feature3 records

Partnerships

Five partnerships are on record, tiered core and flagship.

• Collective HealthcoreTechnology or Integration · 2 April 2025Providence Health Plan partnered with Collective Health to introduce a new TPA platform for self-funded employers, combining Providence's regional healthcare expertise with Collective Health's technology. The platform aims to improve healthcare benefits management, transparency, and cost efficiency, with Collective Health's clinical and analytical tools projected to reduce healthcare cost trends by 50% over five years.
• American Heart AssociationcoreStrategic or Co-development Partner · 7 February 2025Providence Health Plan and American Heart Association partnership targeting cardiovascular health in local communities through education, awareness, and prevention programs.
• Oregon Food BankflagshipStrategic or Co-development Partner · 13 June 2023As part of the Health For All initiative, Providence Health Plan partnered with Oregon Food Bank to address food insecurity in Portland communities. Providence pledged $390,000 in total donations and caregivers committed 1,000 hours of community service to assist the organization.
• North by Northeast Community Health CenterflagshipStrategic or Co-development Partner · 13 June 2023Partnership under Health For All initiative providing health education and support to underserved communities in the Portland area.
• Central City ConcernflagshipStrategic or Co-development Partner · 13 June 2023Partnership supporting homeless, at-risk, low-income, and underinsured populations of Portland Metro area through housing and healthcare services.

Scale indicators7 records

Recent moves10 records

Expansion highlights4 records

Direct peers

• Regence BlueCross BlueShield of Oregon: Direct Oregon-market competitor offering commercial, Medicare, and individual health plans to overlapping employer and consumer segments. Most apples-to-apples peer for Providence Health Plan's commercial book in Oregon.
• Kaiser Permanente Northwest: Integrated payer-provider health plan competing directly in Oregon and southwest Washington with HMO products, employer group plans, and Medicare Advantage—structurally the closest integrated competitor to Providence.
• Moda Health: Oregon-based nonprofit health plan offering commercial, Medicare Advantage, and Medicaid in the same regional footprint. Comparable scale, Oregon regulatory exposure, and product mix.
• PacificSource Health Plans: Oregon-headquartered nonprofit health insurer offering group, individual, Medicare Advantage, and Medicaid plans across the Pacific Northwest. Closest peer by company type (nonprofit), geography, and product mix.

Regional players

• Premera Blue Cross: Pacific Northwest regional Blue Cross plan serving Washington and Alaska with commercial, Medicare, and ASO products. Comparable regional carrier profile though operating in adjacent rather than overlapping states.

Broad incumbents

• UnitedHealthcare: Largest U.S. health insurer and the national carrier most likely to absorb Providence's Medicare Advantage book under the planned partnership; competes in Oregon across all lines.
• Humana: National Medicare Advantage–focused carrier; relevant given Providence's intent to retain MA operations through a national-carrier partnership and Humana's MA scale and Star-rating expertise.
• Elevance Health (Anthem Blue Cross Blue Shield): Major national Blues-affiliated carrier with significant commercial and Medicare Advantage presence; one of the plausible strategic acquirers for Providence's residual book.
• The Cigna Group: National carrier with strong employer-group and stop-loss capabilities; relevant comparator for Providence's ASO/employer business and a possible acquirer of self-funded platform assets.
• CVS Health (Aetna): Vertically integrated payer-retail-PBM conglomerate with Aetna's commercial and Medicare franchises; benchmark for scale and integrated-care economics that Providence's CFO cited as unattainable for regional players.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/providenceplan
• Facebookfacebook.com/ProvidenceHealthPlan
• LinkedInlinkedin.com/company/providence-health-plan
• Instagraminstagram.com/providencehealthplan

Revenue estimate

Valuation estimate

Number of profiles

Profiles12 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Providence Health Plan