News Summary
Excellus BlueCross BlueShield has revealed a 20.7% premium hike for individuals using New York’s health insurance marketplace. This significant increase is the second-largest among state insurers. While the average rise across other insurers is only 7.1%, the change will affect 240,000 New Yorkers enrolled in the Affordable Care Act marketplace. A 15% increase will also impact the small-group market. Factors leading to these increases include rising hospital care costs and prescription medications, raising concerns about healthcare affordability for state residents.
New York – Excellus BlueCross BlueShield has announced a significant premium increase of 20.7% for individuals purchasing insurance through New York’s health insurance marketplace in 2026. This increase marks the second-largest rate hike among all insurers in the state.
Currently, the average premium increase across the dozen insurers within the individual Affordable Care Act (ACA) marketplace is substantially lower at 7.1%. Approximately 240,000 New Yorkers enrolled in the ACA marketplace last year will be impacted by Excellus’s premium adjustment.
The New York State Department of Financial Services oversees and regulates these premium adjustments. Notably, this is the second consecutive year that Excellus has received a considerable increase in its individual market premiums, having previously been approved for an 18.3% increase in 2024, against a statewide average of 12.7%.
Impact on Small-Group Market
Excellus will also implement a 15% rate increase in the small-group market for 2026. This increase is slightly above the 13% average raise anticipated among the other small-group insurers. The small-group plans cover approximately 685,000 New Yorkers who are part of employers with 100 members or fewer.
Factors Driving Premium Increases
Excellus attributes these premium increases primarily to escalating costs associated with hospital care and prescription medications. State regulators have also pointed to high hospital occupancy rates and rising drug expenses as systemic contributors to the ongoing escalation of insurance premiums.
Insurance companies are facing a controlled profit margin of only 1% for the upcoming year as mandated by state regulators. This limitation is aimed at ensuring that insurance providers maintain a focus on patient care over profit-making.
Comparison to National Trends
On a national scale, marketplace premiums are projected to rise by 18% in the coming year, which outpaces New York’s planned increases. In stark contrast, last year national premiums grew by merely 7%, which was lower than New York’s average uptick of 12.7%.
Excellus’s regulated plans currently represent about 10% of its total membership, which stands at 1.5 million. The organization reports that 92% of its premiums are allocated towards patient care. Despite incurring a $163 million loss from daily operations in the previous fiscal year, the non-profit managed to record a $25 million profit for 2024 through investment revenue.
Broader Health Systems Impact
St. Joseph’s Health, a significant local healthcare provider, has reported losses totaling $100 million over the last five years and is seeking increased contracting rates from Excellus to stabilize its financial footing. However, Excellus contends that substantial hikes in contract rates could potentially burden the 35,000 local residents utilizing their services at St. Joseph’s.
As New Yorkers navigate these changes, the ongoing escalation in premium rates raises overarching concerns about healthcare affordability and access within the state. Stakeholders continue to watch closely as both insurers and patients adapt to the evolving healthcare landscape influenced by ever-rising costs.
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Author: STAFF HERE NEW YORK WRITER
NEW YORK STAFF WRITER The NEW YORK STAFF WRITER represents the experienced team at HERENewYork.com, your go-to source for actionable local news and information in New York, the five boroughs, and beyond. Specializing in "news you can use," we cover essential topics like product reviews for personal and business needs, local business directories, politics, real estate trends, neighborhood insights, and state news affecting the area—with deep expertise drawn from years of dedicated reporting and strong community input, including local press releases and business updates. We deliver top reporting on high-value events such as New York Fashion Week, Macy's Thanksgiving Day Parade, and Tribeca Film Festival. Our coverage extends to key organizations like the Greater New York Chamber of Commerce and United Way of New York, plus leading businesses in finance and media that power the local economy such as JPMorgan Chase, Goldman Sachs, and Bloomberg. As part of the broader HERE network, including HEREBuffalo.com, we provide comprehensive, credible insights into New York's dynamic landscape.
