Health insurance companies to make changes to prior authorizations
HHS secretary Robert F. Kennedy and Dr. Mehmet Oz announced that major insurance companies have agreed to cut down and streamline prior authorizations
- Health insurers in New York have requested an average rate hike of 13.5% for individuals in that Affordable Care Act, or ACA, marketplace and related programs in 2026.
- The proposed rate hike for small group plans was a striking 24%.
- Many large employers also plan to shift more healthcare costs to employees through higher deductibles and out-of-pocket expenses.
Consumers who buy health insurance through the New York State-run Affordable Care Act marketplace could face double-digit percentage rate hikes next year.
That’s because health insurers in New York have requested an average rate hike of 13.5% for individuals in that Affordable Care Act, or ACA, marketplace and related programs. The proposed rate hike for small group plans was a striking 24%, state records show.
By contrast, insurers across the country plan a median ACA premium increase of 15% for 2026 plans, which would be the largest ACA insurance price hike since 2018, according to a Peterson-KFF Health System Tracker analysis published July 18.
Why are health insurance costs spiking in NY?
The proposed rate increases in New York would impact about 1 million New Yorkers who are enrolled in individual and small group plans directly through private insurers or through the state’s ACA health exchange, NY State of Health.
Health insurers asserted the reasons driving the need to increase rates included:
- Continued increases in hospital prices, which are expected to rise by nearly twice the rate of inflation during 2025-2026 according to data from the Centers for Medicare and Medicaid Services.
- High and ever-escalating prices that pharmaceutical companies continue to charge for prescription drugs.
- The number ofmandated benefits, with New York lawmakers approving nine bills this year for new benefits that would be added to the current list of specific treatments or services required to be covered, as well as other related health policies.
- Taxes on health insurance, which total more than $6.6 billion annually, adding to the cost of health insurance and increasing the annual premium for the average family buying a policy in New York by more than $1,000.
- The impact of current federal budget actionsthat will increase average monthly costs by $114 for an individual and $228 for a couple, according to estimates from the NY State of Health.
Still, the proposed rate hikes for next year have yet to be approved by the state Department of Financial Services, which has a history of reducing the rate increases sought by insurers. The final rates for next year will be approved in late August.
As they stand, the propose rate increases for next year vary from a high of 66% through UnitedHealthcare Insurance Company of New York to a low of nearly holding flat for Emblem.
Other factors driving up health insurance rates in New York and nationally included the expiration of tax credits instituted during former President Joe Biden‘s administration that made plans cheaper, and tariffs on prescription drugs and medical device imports, USA TODAY reported.
How much have NY health insurance rates increased in the past?
From 2019 to 2023, average rates for individual plans increased by a total of 31.4%, with an average yearly rise of about 6%. Small-group plans saw a total increase of 30.6% during the same period, an industry study reported.
More: What documentation is required for Medicaid in New York state? A guide
The rates for individual plans in 2025 increased by an average of 12.7%, while small-group plan rates increased by 8.4%. Those rate increase percentages were about the same as the rate hikes in 2024.
For further details about specific health insurers’ proposed rate increases for 2026, visit the state regulatory agency’s website, at dfs.ny.gov. You can also submit a comment about the requested increases through the agency’s online portal.
The agency also has a consumer hotline that is staffed Monday through Friday, from 8:30 a.m. to 4:30 p.m. at (800) 342-3736.
What about employer-provided health insurance costs?
At the same time, many working-age consumers in New York who get their health insurance through the workplace won’t be spared from cost hikes next year, either. Benefits consultant Mercer said more than half of big employers nationally expect to shift a larger share of insurance costs to employees and their families next year by raising deductibles, copays or out-of-pocket requirements.
Includes reporting by Ken Alltucker of USA TODAY.