News Summary
Excellus BlueCross BlueShield has announced a significant 20.7% increase in health insurance premiums for individuals in New York’s marketplace. This steep rise, attributed to escalating healthcare costs related to hospital care and prescription drugs, follows an 18.3% increase in the previous year. Approximately 240,000 New Yorkers will feel the impact, while the average rate increase across other insurers is considerably lower at 7.1%. State regulators continue to oversee these changes as healthcare expenses rise nationwide, with projected premium increases expected to reach 18% in 2026.
New York State Set to See Major Premium Increases for Health Insurance
Excellus BlueCross BlueShield has announced a 20.7% increase in health insurance premiums for individuals purchasing coverage through New York’s health insurance marketplace in 2026. This rate hike marks the second-largest increase approved among insurers in New York State, following a broader trend of escalating health care costs.
Approximately 240,000 New Yorkers purchased coverage through this individual marketplace last year, and they will bear the brunt of this steep premium increase. The average rate increase among a dozen insurers participating in the individual Affordable Care Act marketplace is significantly lower at 7.1%.
Reasons for the Increase
Excellus has attributed the premium rise to the increasing costs and demand for health care services, with specific focus on hospital care and prescription drugs. State regulators have also noted that rising costs associated with in-patient hospital stays and rapidly climbing drug prices are primary contributors to the overall increases in premiums across New York.
In addition to the individual market increase, Excellus obtained a 15% approval increase for small-group plans covering employers with 100 or fewer members, a notable increase compared to the 13% average rise for all insurers in this segment.
Historical Context and Financial Performance
This new premium adjustment follows a significant 18.3% hike permitted in 2024, making this the second consecutive year Excellus has seen such substantial increases in its individual market premiums. The average rate hike statewide for the year 2024 was 12.7%.
Excellus, with a total membership of 1.5 million, reported a loss of $163 million in operational activities last year, followed by a modest profit of $25 million in 2024, primarily owing to investment revenue. In a worrying trend, Excellus also shared that it recorded a loss of $23.2 million in 2023, marking its first loss since 2008.
Impact on New Yorkers and Future Projections
With state regulators mandating that insurance providers maintain a 1% profit provision for the upcoming year, these premium increases may foreseeably affect over 35,000 Central New Yorkers who are treated at St. Joseph’s Health, which has reportedly lost $100 million over the past five years. In response to its financial challenges, St. Joseph’s is seeking a substantial rate increase from Excellus to help stabilize operations.
Nationally, health insurance premiums are projected to rise by 18% in 2026, which surpasses New York’s considerable increase. This shift from the previous year, where national marketplace premiums only experienced a 7% increase, suggests a growing trend of higher health costs across the board.
The New York State Department of Financial Services regulates premiums for health insurance, which do not include members from the Essential Plan, Medicare, Medicaid, or large employer insurance categories. Excellus asserts that 92% of its premiums are redirected back to patient care, attempting to mitigate concerns regarding consumer spending on health insurance.
Despite the challenges, Excellus remains a key player in the New York health insurance landscape, as consumers navigate rising costs in pursuit of quality health coverage.
Deeper Dive: News & Info About This Topic
- Syracuse.com: Central NY’s Largest Health Insurer Raising Rates
- Wikipedia: Health Insurance in the United States
- Syracuse.com: Excellus Reports 2024 Profit Amid Losses
- Google Search: Health Insurance Premium Increases 2026
- Syracuse.com: St. Joe’s Losing Millions, Excellus Patients Affected
- Google Scholar: Health Insurance Rate Increase
- CNY Central: Excellus Customers to See Rate Increases
- Encyclopedia Britannica: Health Care
- Syracuse.com: St. Joseph’s Extends Excellus Benefits
- Google News: Excellus BlueCross BlueShield
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.
