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Each year, HCFANY submits comments to the Department of Financial Services (the Department) as part of the State\u2019s rate review process<\/a>. The annual rate review process allows the Department to regulate health insurance premiums for the ACA marketplace. HCFANY\u2019s comments focus on carriers offering products on New York\u2019s individual market<\/u><\/strong> and cover the rate applications of all 12 carriers (health insurance companies) with on-exchange products. These letters submitted by HCFANY are linked below, by carrier.<\/p>\n New York\u2019s individual market carriers are seeking a weighted average premium increase of 20.7 percent<\/u><\/strong>, which is over five times the rate of inflation<\/a>. If this year\u2019s requests are approved, it will result in an average premium increase of 64 percent over the last five years, with four carriers\u2019 premiums doubling in this period. In other words, if rates are approved, there will be an average premium increase of $390 per month<\/u><\/strong>, over the last five years.<\/p>\n Consumers with job-based coverage have employers, brokers, and agents who can negotiate the best premiums, scope, and coverage for their employees. By contrast, consumers in the individual market have no bargaining power over affordable premiums and out-of-pocket costs. This population depends on the Department to safeguard health insurance affordability through the annual process of rate review.<\/p>\n Rate requests for the 2027 plan year coincide with two counteracting changes in the individual market:<\/p>\n The American Rescue Plan expired at the end of 2025, and the federal government did not extend the eAPTCs. As a result, many individuals lost federal financial assistance with health insurance premiums and exited the market. Since last year, around 46,600 enrollees have left the market.<\/p>\n As a result of the State\u2019s return to the Basic Health Program, 444,000 individuals who were previously covered through the Essential Plan lost eligibility on July 1, 2026. A portion of this population is expected to return to the individual market, likely counterbalancing the number leaving the market due to the expiration of eAPTCs.<\/p>\n The annual claim trend is the portion of the rate request based on changes in prices and utilization of medical and pharmaceutical care. New York\u2019s carriers submitted inconsistent annual claim trend estimates, indicating that many have not effectively controlled health care costs<\/u><\/strong>. The carriers\u2019 estimates for the 2027 plan year range from 8.9 percent to 14.7 percent, with a weighted-average trend rate of 11.5 percent. This trend appears inflated and is a significant jump from the 6.7 percent approved trend over the past five years.<\/p>\nMarket changes<\/u><\/h3>\n
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Medical inflation (claim trend)<\/u><\/h3>\n
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