New York health premiums to rise 6% after regulator trims hikes

New York's insurance regulator denied $1.57 billion of the premium increases insurers sought for 2027, approving average hikes of 6 percent in the individual market and 8 percent for small-group plans sold on the state-run marketplace.

"Suppressing rates in the name of affordability does nothing to contain the cost of care," Eric Linzer, president and chief executive of the New York Health Plan Association, said. "Instead, it ignores the ongoing escalation of provider and pharmaceutical prices."

The approved individual-market increase compares with the 20.6 percent average insurers sought, while small-group rates were trimmed from a requested 23.7 percent, the Department of Financial Services said. The decision affects 224,000 people in the individual market and 630,000 enrolled through small-business plans sold on the state's health-insurance portal. Outcomes varied by carrier: CDPHP, based in Albany, was granted no increase after requesting 1.4 percent, while MVP Health Plan in Schenectady received its full requested 10.4 percent. On the small-group side, Anthem HealthChoice Assurance members face a 14.4 percent rise, while Emblem (HIP) customers get a 0.7 percent reduction.

The decision follows a 7.1 percent average increase for individual plans in 2026 and a 13 percent rise for small-group coverage, and comes as the per-employee cost of employer-sponsored healthcare is projected to climb 8.2 percent in 2027, the steepest rise in more than two decades, according to a Mercer study. DFS said rejecting the proposals saved about 860,000 New York consumers and small businesses roughly $1.6 billion.

Insurers pushed back on the outcome, arguing the approved rates do not cover actual costs. The New York State Conference of Blue Cross and Blue Shield Plans, which represents Excellus, Empire, HealthPlus and Highmark carriers covering 5 million people, called the rates "artificially suppressed" and pointed to government mandates and drug costs as drivers policymakers need to address. "Given the exponential growth of healthcare costs here in New York, we hope that policymakers will begin to take the obvious steps, within their power, in controlling many of these cost drivers," Lev Ginsburg, executive director of the group, said.

The gap between what carriers sought and what regulators allowed widened this cycle. Individual-plan premiums rose a combined 31.4 percent from 2019 to 2023, an average of about 6 percent a year, while small-group plans increased 30.6 percent over the same period, according to state records. The 2027 outcome keeps the individual-market trajectory near that historical pace even as insurers requested increases roughly three times larger, a sign that underlying medical and drug costs are climbing faster than the state is willing to pass on to consumers.

The tension between affordability and marketplace stability is likely to persist into the next rate cycle. Insurers warn that repeatedly holding approved increases below claimed costs could push carriers to exit the individual and small-group markets, thinning consumer choice, while the state counters that its actions have already lowered what residents pay for preventive and primary care, including eliminating out-of-pocket costs for insulin, inhalers and lung cancer screenings.

For New Yorkers who buy coverage on the state's marketplace, the practical effect is a range of outcomes depending on carrier and plan. Consumers can compare approved 2027 rates by insurer on the DFS website at dfs.ny.gov, and should verify the latest figures against official announcements before open enrollment.

This article is for informational purposes only and does not constitute professional or investment advice.