New York health insurance regulators denied $1.57 billion in requested rate hikes for individuals and small businesses, according to the state Department of Financial Services. The agency announced that while insurers sought average increases of 20.6% in the individual market and 23.7% for small businesses, actual 2026 rates will rise by an average of 6% and 8% respectively.
Understanding New York Health Insurance Rate Reductions
The Department of Financial Services oversees policies for 224,000 individuals and 630,000 small business employees who buy coverage outside of employer or government plans. Outcomes varied by provider across the state. CDPHP in Albany requested a 1.4% increase in the individual market and received no increase at all, while MVP Health Plan in Schenectady asked for a 10.4% increase and was approved for the full amount, according to state records.
State officials attributed the intervention to broader administrative efforts to lower out-of-pocket medical expenses. “The governor has taken action to reduce what New Yorkers pay for in preventative and primary care, including eliminating out of pocket costs for insulin, inhalers, and lung cancer screenings,” the Department of Financial Services stated.
Pro Tip: Check Your Marketplace Plan Details
If you buy coverage through the state’s health insurance portal, review your specific carrier’s approved rates during the open enrollment window rather than relying on statewide averages.
Insurer Pushback and Broader Market Pressures
Large health plans argued that state interventions do not reflect actual medical expenses. The New York State Conference of Blue Cross and Blue Shield Plans asserted that approved rates were “artificially suppressed” and failed to cover actual costs. Serving 5 million individuals, this organization speaks for Highmark Blue Cross Blue Shield of Western New York, Empire Blue Cross Blue Shield HealthPlus, Empire Blue Cross Blue Shield, and Excellus Blue Cross Blue Shield.
A statement issued by Lev Ginsburg, executive director of the New York State Conference of Blue Cross and Blue Shield Plans, included these remarks.
| Market Segment | Average Requested Increase | Approved Increase | Enrollee Count |
|---|---|---|---|
| Individual Market | 20.6% | 6% | 224,000 |
| Small Business Market | 23.7% | 8% | 630,000 |
National Trends in Employer Healthcare Costs
Employer-sponsored health plans face separate pressures nationwide. Employer healthcare costs are on track to climb about 11% nationally, which marks the sharpest jump in more than two decades, according to a survey of 1,800 employers released by benefits consulting firm Marsh and reported by The New York Times. Companies expect to hold that increase closer to 8% by scaling back what their health plans cover.
“This year was a rough year, and next year looks like it will be even rougher,” Beth Umland, Marsh’s director of employer research for health and benefits, told The New York Times. Roughly 160 million Americans under age 65 receive health insurance through an employer, facing potential increases in premiums, deductibles, and co-pays.
Did You Know?
Frequently Asked Questions
What is the Department of Financial Services?
The New York Department of Financial Services regulates health insurance policies sold to individuals and small businesses with 100 or fewer employees who do not receive coverage through an employer or government program.
Why did insurers request rate increases?
How much did regulators cut from the proposed rate hikes?
The state Department of Financial Services denied $1.57 billion in total rate hike requests across the individual and small business markets.
Do these rate decisions affect large employer plans?
No. The Department of Financial Services does not regulate large employer health insurance plans, though costs in that market are following a similar upward trajectory.
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