New York health insurance marketplace guide 2023

New York has fully embraced the Affordable Care Act, with a state-run exchange, called New York State of Health. It is one of the most robust exchanges in the country, with 12 insurers offering individual market plans for 2023. (Plan availability varies considerably from one county to another, and some insurers sell plans under more than one name).

There are also 12 insurers offering Essential Plan coverage for 2023 (this is New York’s Basic Health Program — details below; availability varies from one county to another), and seven insurers offering small business plans through NY State of Health’s SHOP exchange (plan availability varies from one county to another; some insurers market plans under more than one name).

The same twelve insurers that offered exchange plans in New York for 2022 are continuing to do so for 2023:

• Capital District Physicians’ Health Plan (CDPHP)
• Emblem (Health Insurance Plan of Greater New York)
• Excellus Health Plan
• Fidelis (New York Quality Health Care Corp.)
• Healthfirst PHSP
• Health Plus HP (formerly Empire)
• Highmark Western and Northeastern New York (formerly HealthNow)
• Independent Health Benefits Corporation
• Metro Plus Health Plan
• MVP Health Plan
• Oscar
• UnitedHealthcare of New York

New York has had a robust exchange from the start, with multiple insurers offering plans in most areas of the state. 

• insurer participation by county in 2020
• insurer participation by county in 2021
• insurer participation by county in 2022

For the most part, insurer participation has been fairly stable in New York’s exchange. But there have been a few changes over the years:

• WellCare exited the individual QHP market at the end of 2016 (but continued to offer the Essential Plan coverage). Their enrollee count in exchange QHPs was only about 1,000 members in 2016.
• American Progressive Life and Health Insurance Company of NY didn’t offer policies for 2015 after gaining a very small market share in 2014.
• WellCare joined the exchange in 2015 but only offered plans for two years. They stopped offering exchange plans at the end of 2016.
• Health Republic closed in late 2015, so their policies were not available for 2016 or later years (more details below).
• For 2016, Health Republic was no longer available.
• Affinity Health Plan, which had 6,353 enrollees in 2017, exited the individual health insurance market in New York at the end of 2017. They did not offer 2018 coverage on or off-exchange.
• CareConnect, operated by Northwell Health, New York’s largest hospital system, announced in August 2017 that they would shut down Care Connect Insurance Company over the coming year. The insurer stopped offering coverage at the end of 2017. Their 31,266 members in the individual market had to select new coverage for 2018. CareConnect also had 79,337 members in the small group market; those plans were allowed to remain in force until their renewal date in 2018.

In September 2017, Centene announced plans to acquire Fidelis Care’s assets. (Technically the transaction was “an asset purchase, rather than an outright acquisition” in order to comply with New York regulations regarding the purchase of nonprofit organizations.) Centene did not previously participate in New York’s market, but the acquisition of Fidelis Care gave the company major foothold there, given Fidelis Care’s market share.

Centene agreed to pay $3.75 billion to purchase Fidelis Care’s assets, but the state believed that the majority of that money should go to the state, since Fidelis Care’s primary business is Medicaid managed care. A deal was reached in March 2018 that allows the state to receive $2 billion from the sale, with the money earmarked for a healthcare charitable trust to benefit New Yorkers and improve health care in the state. In April 2018, the New York Department of Health and the New York Department of Financial Services both granted approval for the acquisition, and the details were finalized by the end of 2018.

In New York, the open enrollment period has both a start and end date that differ from the schedule used in most other states. And New York has also been keeping its enrollment portal open throughout the COVID public health emergency, which is scheduled to continue through May 11, 2023.

Normally, open enrollment starts November 16 in New York, and continues through January 31 (as opposed to the November 1 – January 15 schedule that’s used in most of the rest of the country).

But enrollment was open throughout 2022 in New York, due to the ongoing COVID public health emergency. And that continues to be the case in early 2023. The federal COVID public health emergency is slated to end on May 11, 2023.

So from May 12 until November 16, 2023 (when open enrollment begins for 2024 coverage in New York), New Yorkers will need to have a qualifying event in order to sign up for private qualified health plans.

But enrollment in Medicaid, Child Health Plus, and the Essential Plan will continue to be available year-round for people who are eligible for those programs. 

The overall weighted average rate change for 2023 qualified health plans in New York amounted to an increase of 9.7%. This was larger than the national average for 2023, but it was only a little more than half of the rate increase that New York’s insurers had proposed for 2023. As has been the case in prior years, the NY Department of Financial Services approved significantly smaller rate increases than the insurers had proposed.

The following average rate changes were approved for the insurers that offer individual/family coverage through New York State of Health (rate changes are calculated before premium subsidies are applied; data regarding the number of enrollees for each insurer can be found here):

• Capital District Physicians’ Health Plan (CDPHP): 16.5% increase
• Emblem (Health Insurance Plan of Greater New York): 9% increase
• Health Plus HP (formerly Empire): 0.5% increase
• Excellus Health Plan: 10% increase
• Fidelis (New York Quality Health Care Corp): 12.4% increase
• Healthfirst PHSP: 8.3% increase
• Highmark Western and Northeastern New York (formerly HealthNow): 12.8% increase
• Independent Health Benefits Corporation: 6.1% increase
• Metro Plus Health Plan: 8.1% increase
• MVP Health Plan: 10.1% increase
• Oscar: 6.5% increase
• UnitedHealthcare of New York: 9.2% increase

It’s important to understand that net rate changes for people who receive premium subsidies can be quite different from the overall rate changes for that person’s plan, since it also depends on how the benchmark plan premium changes.

For perspective, here’s a look back at rate changes for NY State of Health plans since 2014:

2014: ACA-compliant plans debuted in 2014. And although premiums in most states increased as insurers switched from medically underwritten to guaranteed issue coverage, that was not the case in New York. Premiums were already high in New York, as the state had required guaranteed issue coverage for more than two decades. So premiums in New York in 2014 were lower than they had been the year before (thanks to the ACA’s individual mandate, which New York didn’t have in previous years).

2015: Average increase of 5.7%. Rates for 2015 were approved in New York in early September 2014. In the individual market (both on and off-exchange), the average approved rate increase was just 5.7% – a significant decrease from the 12.5% that carriers had originally filed with the state.

2016: Average increase of 7.1%. In the individual market, carriers had requested an average rate increase of 10.4 percent for 2016, but regulators knocked that down to 7.1 percent — and some insurers reduced their average prices for 2016. Health Republic initially had the highest approved rate increase (14 percent), but their plans terminated at the end of November 2015 (details below). Since all of Health Republic’s individual enrollees had to switch to other carriers during open enrollment, the final weighted average rate increase ended up being less than the 7.1% that regulators had initially stated.

2017 Average increase of 16.6%. Nationwide, the average pre-subsidy premium increase was about 25% for 2017, while New York’s weighted average rate increase for the individual market was 16.6%. So although NY had a double-digit average increase, premiums in the state were more stable than they were in other states.

2018 Average increase of 13.9%. Insurers proposed an average increase of 17.7% for 2018 individual market plans, but NYDFS approved an average rate increase of 13.9%.

NY Upstate reported on May 15 that insurers in New York would be requesting “double-digit rate hikes because of continued increases in health care costs and uncertainty related to federal discussions surrounding repealing and replacing the Affordable Care Act.”

In their summary of rate filings for 2018, NYDFS included this:

“to prepare for potential changes to the Affordable Care Act, DFS requested that insurers provide estimates as to how the impact of a potential repeal of the individual mandate and the loss of Cost Share Reduction (CSR) funding would affect rates. Of those that provided numerical estimates, on average, insurers estimated that a full repeal of the federal individual mandate would increase rates by an additional 32.6% and the loss of CSR funding would increase rates an additional 1.3%.“

The elimination of CSR funding had less of an impact in New York than it would in most other states (for example, Pennsylvania regulators estimated that loss of CSR funding would increase premiums by more than 20 percent). That’s because of New York’s Essential Plan, which covers people with income up to 200% of the poverty level. CSR is available to people with income up to 250% of the poverty level, but its impact is much smaller when incomes are above 200% of the poverty level. In most states, people with income up to 200% of the poverty level are eligible for substantial CSR benefits, but that’s not the case in New York, since those residents are instead eligible for the Essential Plan.

2019: Average increase of 8.6%. The average approved rate increase for 2019 was 8.6%. But that was quite a bit lower than insurers had proposed. A recurring theme in each insurer’s filing was the fact that the impending elimination of the individual mandate penalty (after the end of 2018) was a major factor in the proposed rate increases. After reviewing the proposed rates, DFS noted that the average proposed rate increase was 24 percent, but it would only have been 12.1% if the federal government hadn’t repealed the individual mandate penalty.

It’s worth noting that in the 90s, New York implemented guaranteed-issue and community rating, but did not impose any sort of mandate. The predictable result of that was skyrocketing premiums and dwindling insurer participation in New York’s individual market. But New York’s pre-2014 market also didn’t have limited enrollment periods or premium subsidies for middle-class enrollees, and those factors have helped to stabilize the individual market and prevent the sort of death spiral that it experienced in the pre-ACA years. But the loss of the individual mandate penalty was by far the single biggest factor in the higher rates that New York insurers were proposing for 2019.

Maria Vullo, DFS Superintendent, previously explained in an op-ed that the actions the Trump administration and GOP lawmakers have taken (elimination of the individual mandate in 2019, the elimination of cost-sharing reduction funding, and the shorter open enrollment period) were resulting in higher health insurance premiums in the individual market. But Vullo clarified that DFS would “be particularly focused on making sure that insurers do not use the chaos and fear-mongering from Washington over the last 18 months as a cover for excessive increases.”

And sure enough, when the approved rate increases for 2019 were announced in August 2018, they were dramatically smaller than insurers had proposed.

2020: Average increase of 6.8%. Across all plans in the individual market, the average proposed increase was 9.2 percent. But regulators spent several weeks reviewing the rates, and as in past years, the overall average approved rate increase of 6.8 percent was smaller than the insurers proposed.

Outside the exchange, HealthFirst Insurance Company offers off-exchange-only plans. An average rate increase of 9.8 percent was approved for their plans for 2020. HealthFirst Ins. Co. had just 149 enrollees in 2019.

Crystal Run Health Plans, which had only been offering coverage outside the exchange in New York, wound down its health plans at the end of 2019 and did offer coverage for 2020. UnitedHealthcare Insurance Company of New York, which only offered plans outside the exchange had had just 52 enrollees in 2019, had proposed an average rate increase of  29 percent for 2020, but their filing was not included among the approved rates for 2020.

New York continues to instruct insurers to add the cost of cost-sharing reductions (CSR) to the premiums for all individual market silver plans, since the federal government is no longer funding CSR.

2021: Average increase of 1.8%. In June 2020, New York’s Department of Financial Services posted insurers’ rate filings for 2021 coverage, which amounted to a weighted average rate increase of 11.7%.

But in August, once the rate review process was completed, NYDFS announced that the overall approved average rate increase for the individual market would be just 1.8% — the smallest percentage increase in the last decade. And in the small group market, the average approved rate increase was 4.2%, as opposed to the 11.4% average increase the insurers had proposed.

2022: Average increase of 3.7%. The overall weighted average rate increase for 2022 amounted to 3.7%, which was the second-smallest percentage increase since ACA-compliant plans became available in 2014.

New York’s individual/family market insurers initially proposed a weighted average rate increase of 11.2% for 2022, but as had been the case over the last several years, the New York Department of Financial Services approved rate increases that were quite a bit smaller than the insurers proposed.

During the open enrollment period for 2022 coverage, 221,895 people enrolled in private qualified health plans (QHPs) through NY State of Health. By mid-January 2023, enrollment in QHPs through NY State of Health had reached 212,580. Open enrollment was still ongoing at that point, and continues through May 11 in New York (the end of the federal COVID public health emergency). 

But the majority of the exchange’s enrollees have coverage through Medicaid, the Essential Plan (more than 1.1 million enrollees by early 2023), or Child Health Plus, with total enrollment across all programs standing at more than 6.5 million people by mid-2022. 

For perspective, here’s a look at QHP enrollment in New York State of Health since 2014:

• 2014: 370,451 people enrolled in QHPs
• 2015: 408,841 people enrolled in QHPs
• 2016: 271,964 people enrolled in QHPs [enrollment dropped because New York’s Essential Plan (Basic Health Program) debuted for 2016, and people who had previously been receiving premium subsidies for QHPs became eligible for the Essential Plan instead. By the end of the open enrollment period for 2016, there were 379,559 people enrolled in the Essential Plan.]
• 2017: 242,880 people enrolled (plus 665,324 people enrolled in The Essential Plan)
• 2018: 253,102 people enrolled in QHPs (plus 738,851 people enrolled in The Essential Plan)
• 2019: 271,873 people enrolled in QHPs (plus 790,152 people enrolled in The Essential Plan)
• 2020: 272,948 people enrolled in QHPs (plus 796,998 people enrolled in The Essential Plan)
• 2021: 215,889 people enrolled in QHPs (plus 914,000 people enrolled in The Essential Plan by late summer 2021) Note that 215,889 was the official CMS enrollment total as of the initially scheduled end of open enrollment. But open enrollment was extended due to COVID, and NY State of Health reported that the enrollment total had grown to 220,000 by the end of May 2021.
• 2022: 221,895 people had enrolled in QHPs during the regularly schedule enrollment window. But New York’s open enrollment period for 2022 coverage continued throughout 2022, due to the COVID public health emergency. As of mid-2022, QHP enrollment stood at 225,726 people. 

In New York, the individual market grew by 89% in 2014 – the fourth-highest percentage growth increase in the country. Nationwide, individual market growth was 46%. The extreme growth in NY’s individual market was largely due to the fact that coverage became much more affordable in the state — even for people who didn’t qualify for premium subsidies — which was not the case in most states; New York already had guaranteed-issue coverage pre-ACA, whereas most states transitioned from medical underwriting to guaranteed-issue as of 2014.