NY health plans seek average 13.5% hike for 2016
Get ready to pay more for health care next year.
The battle over setting next year's health insurance premiums in New York is underway after proposals seeking double-digit rate increases on average were submitted to state regulators.
Proposed rate adjustments vary widely, with an average increase of about 13.5 percent. While some health plans seek up to 30 percent rate increases, others have presented slight decreases, state records filed this month show.
Health insurance premium rates in 2016 for individual and small group plans — as opposed to larger employer-sponsored coverage plans — will ultimately be set by the state Department of Financial Services under the prior-approval process, which essentially gives the agency authority to approve or reduce the rates requested.
Paul Macielak, president and CEO of New York Health Plan Association, a trade and lobbying group representing health insurers, said the proposed rates are justified. He noted many health plans have suffered financial losses the last two years after state regulators significantly reduced premium requests.
"(Health) plans cannot be expected to continue losing money year after year and remain viable," Macielak said.
Similar debates over premiums unfolded last year. Health plans sought double-digit average increases that were eventually reduced by the state Department of Financial Services.
The average premium rate increase for the current year was nearly 6 percent, which was reduced from the 13 percent requested by health insurance companies in 2014.
"While everyone is focused on the rates plans are requesting, there's been little attention given to the underlying cost of care," Macielak said. "Increased pharmacy costs — including high-cost specialty drugs such as Sovaldi and Harvoni — and hospital consolidations continue to drive up the costs of providing coverage, and these rising costs continue to go unchecked."
Meanwhile, state lawmakers are pursuing legislation that would change how the Department of Financial Services sets insurance premium rates. Debate involves weighing the impact of political influence and lobbying on the rate-setting process.
That includes a bill seeking to redefine the criteria regulators use for the prior approval process, which would require them to provide more fiscal details. The state Senate unanimously approved the legislation Monday, sending it to the Assembly for consideration.
Below are proposed premium rate adjustments for 2016 according to the Department of Financial Services. Requests include health plans sold to individuals and small groups, including on the Affordable Care Act state-run marketplace here: New York State of Health.
Figures reflect the weighted average percent increase or decrease in a specific plan's 2016 premium rate requested by each health plan, and the number of members expected to be impacted:
Aetna Life Insurance Company:
23.87 percent increase that impacts 28,067 members on small group plan.
Affinity Insurance Plan
6.63 percent increase that impacts 6,970 members on individual plan.
Capital District Physicians Health Plan Inc.
5.69 percent increase that impacts 3,380 members on individual plan.
19.84 percent decrease that impacts 1,880 members on small group plan.
CDPHP Universal Benefits Inc.
16.56 percent increase that impacts 87,410 members on small group plan.
Empire Health Choice Assurance Inc.
8.70 percent increase that impacts 1,460 members on small group plan.
Empire HealthChoice HMO Inc.
14.50 percent increase that impacts 74,660 members on individual plan.
9.21 percent increase that impacts 10,020 members on small group plan.
Excellus Health Plan Inc.
12.80 percent increase that impacts 28,570 members on individual plan.
13.90 percent increase that impacts 190,230 members on small group plan.
Health Insurance Plan of Greater New York
13.20 percent increase that impacts 23,840 members on individual plan.
29.74 percent increase that impacts 17,513 members on small group plan.
Health Insurance Republic of New York, formerly Freelancer Health Service Corp.
14.36 percent increase that impacts 87,310 members on individual plan.
20 percent increase that impacts 78,980 members on small group plan.
Healthfirst PHSP Inc.
12.89 percent increase that impacts 37,124 members on individual plan.
HealthNow New York Incorporated
6.68 percent increase that impacts 6,630 members on individual plan.
8.06 percent increase that impacts 28,630 members on small group plan.
Independent Health Association
15.60 percent decrease that impacts 1,050 members on small group plan.
Independent Health Benefits Corporation
10.36 percent decrease that impacts 2,390 members on individual plan.
6.19 percent decrease that impacts 25,190 members on small group plan.
Managed Health Inc.
5.60 percent increase that impacts 20 members on small group plan.
MetroPlus Health Plan
7 percent decrease that impacts 27,750 members on individual plan.
0.81 percent decrease that impacts 3,104 members on individual plan.
MVP Health Plan Inc.
13.48 percent increase that impacts 24,000 members on individual plan.
7.28 percent increase that impacts 3,820 members on small group plan.
MVP Health Services Corp.
16.71 percent increase that impacts 31,400 members on small group plan.
New York State Catholic Health Plan
4.66 percent increase that impacts 38,700 members on individual plan.
North Shore-LIJ CareConnect Insurance Company Inc.
4.93 percent increase that impacts 14,990 members on individual plan.
3.27 percent increase that impacts 5,120 members on small group plan.
Oscar Insurance Corporation
4.54 percent increase that impacts 26,360 members on individual plan.
Oxford Health Insurance Inc.
13.61 percent increase that impacts 360,200 members on small group plan.
Oxford Health Plans (NY) Inc.
5.32 percent increase that impacts 14,010 members on individual plan.
10.58 percent increase that impacts 138,300 members on small group plan.
United Healthcare Insurance Company of New York
11.12 percent increase that impacts 70 members on individual plan.
18.79 percent increase that impacts 979 members on small group plan.
United Healthcare of New York Inc.
22 percent increase that impacts 7,860 members on individual plan.
WellCare of New York
4.72 percent increase that impacts 110 members on individual plan.
For more details about specific plan's rate proposals for 2016, visit the Department of Financial Services website.