Individual Market

On average, insurers requested a 12.5 percent increase in health insurance rates for 2015 in the individual market. DFS reduced that average increase more than in half to 5.7 percent – which is below the approximately 8 percent average increase in health care costs.

Most of the average increase (4.5 percent) in individual rates is due to an expected reduction in a federal reinsurance program for insurers, which is provided through the federal Affordable Care Act (ACA). Without the impact of that ongoing phase out, the average increase would have been approximately 1.2 percent.

Many New Yorkers meeting certain income thresholds are also eligible for federal financial assistance when purchasing coverage on the NY State of Health, which would lower costs even further for them. Individuals with incomes below 400 percent of the federal poverty level ($46,680 for individuals and $95,400 for a family of four), can qualify for financial assistance that lowers cost of coverage. These subsidies generally increase in line with premiums – offsetting the impact of rate increases for many consumers. Specific subsidy amounts are based on a consumer’s income level and other factors.

 

2015 INDIVIDUAL MARKET RATE ACTIONS – OVERALL SUMMARY

Company Requested Approved Reduction
Aetna Life Insurance Co. 19.96% 5.32% -14.64%
Affinity Health Plan* -12.58% -15.21% -2.63%
CDPHP* 6.69% 0.15% -6.54%
Emblem-HIP* 9.81% 6.72% -3.09%
Empire BlueCross BlueShield HMO* 18.40% 7.37% -11.03%
Excellus* 19.59% 9.23% -10.36%
Fidelis* 7.14% 3.23% -3.91%
Health Republic Insurance of New York* 15.35% 13.04% -2.31%
Healthfirst* -9.67% -11.95% -2.28%
HealthNow* 7.24% 1.41% -5.83%
Independent Health Benefits Corp.* 5.44% -2.01% -7.45%
MetroPlus Health Plan* 17.78% 6.90% -10.88%
MVP Health Care* 18.31% 9.97% -8.34%
Care Connect (North Shore LIJ)* -1.24% -3.22% -1.98%
Oscar* 6.28% 6.28% 0.00%
Oxford Health Plan 1.08% -9.41% -10.49%
UnitedHealthcare of NY* -5.85% -15.32% -9.47%
All companies 12.50% 5.70% -6.80%

* Companies that offer individual coverage on the NY State of Health Individual Marketplace

(Note: Freelancers Insurance Company, Crystal Run Health Plan, Montefiore Insurance Company and Wellcare of NY* are new entrants to the market and are selling new products with new premium rates, and therefore did not request rate increases. Accordingly, their premium rates are not shown in the above chart.)

The next New York State of Health open enrollment period begins on November 15, 2014 for coverage starting on January 1, 2015. New Yorkers eligible for Medicaid and all children can enroll in coverage through NY State of Health at any time during the year.

The Small Business Marketplace for employers with 50 or fewer employees is open to enrollment throughout the year. For more information about the New York State of Health exchange, please visit, https://nystateofhealth.ny.gov/.