Health insurers seeking to raise premiums on New Yorkers again

Some New Yorkers are shocked as they receive notice that their health insurers want to raise premiums again.

Twelve companies have filed requests with the State Department of Financial Services (DFS) to charge customers who buy their own health insurance more. 

Trainer Gene Schafer and his wife pay roughly $1,800 each month, and their insurer, Oscar, is seeking to raise it to about $2,200. 

"Nobody increases their rates for any of their businesses by 23%. I mean that would be an outrage," Schafer said.

Other insurance companies have also filed requests.

Anthem is seeking an 11% increase, Healthfirst wants nearly 15%, and Fidelis is looking for 28%. 

"Anthem's proposed rates reflect the expected cost of care for 2027. We're seeing increased use of higher-cost services, including emergency room care, behavioral health services, and specialty prescription drugs, along with rising healthcare costs overall," a statement from the company read.

Why are premiums going up?

Insurance companies say the biggest drivers for their rate requests include rising hospital costs, specialty prescription drugs and the expiration of the enhanced premium tax credits.

UnitedHealthcare is requesting the largest increase of 52.1%.

"Our requested rates reflect significant year-over-year increases in medical costs, driven by higher hospital prices, increased utilization, and rising specialty drug costs. We remain committed to working with state regulators to ensure rates are fair, reflect the true cost of care, and maintain market stability," a statement read.

Emblem, which is requesting 26.8%, also noted similar reasons.

"EmblemHealth's filed rate increase for the individual market reflects rising hospital costs, increased specialty drug utilization and costs, and the expiration of the enhanced premium tax credits," a spokesperson said.  

The rate increases are not final yet

The increases won't take effect unless DFS approves them. 

Schafer said he and his wife have been happy with Oscar as their insurance provider.

"We've had good luck with Oscar. They do a nice job," he said.

He said the price has gone up every year.   

"I kind of hold my breath, and hopefully it doesn't pass," Schafer said. "It's a question of 'how do you fix this?' and I don't know the answer."

If you have received a notice about your premium going up, don't panic just yet. Last year, insurers asked for an average increase of about 13%, but DFS cut that to 7%. Data shows requests fell for two years before jumping back for 2027, which nearly matches the 2024 high.  

Consumer Advocate Elisabeth Benjamin said the agency reviews each request, analyzing medical claims, costs and other financial data. She said customers should write to the department so their voices can be heard.

"They read every single one of those comments," she said.

Benjamin recommends anyone who buys their insurance on their own should shop through the state marketplace.

"It's quite likely that you're eligible for a discount," she said. "The catch is you have to do it through the marketplace."

The state is expected to release its final approved rates later this month.

Insurance companies weigh in

CBS News New York reached out to each insurance company that requested a rate increase. 

Statement from CDPHP:

"While health care costs continue to rise, the 2027 CDPHP individual market rate request reflects our ongoing commitment to prudent financial management and operational efficiency. Though this population is relatively small and costs may fluctuate from year to year, a continued focus on value has enabled us to keep our requested premium increase moderate while maintaining access to high-quality care.

Our affiliation with The Lifetime Healthcare Companies further strengthens that effort. As part of a larger organization, we are able to share expertise, streamline operations, and gain economies of scale that help contain costs and enhance the value we deliver to members and the communities we serve.

"We recognize that any increase can be challenging for individuals and families. That's why we remain focused on addressing the underlying drivers of health care costs. We believe these efforts position us to maintain long-term stability and affordability in an increasingly complex health care environment."

Statement from Excellus BlueCross BlueShield:

Excellus BlueCross BlueShield limits rate increases to the lowest amounts possible to cover rising healthcare costs while also maintaining the financial health of our nonprofit health plan.  

Premium rates are primarily the result of the cost and demand for medical care and prescription drugs. Most of what we collect in premiums is spent on member care. Last year, we spent 92 cents out of every premium dollar on healthcare for our members, including doctor visits, hospital stays and prescription drugs. 

Here are examples of what's driving the 2027 rate increase requests for small group and individual plans:

• About half of the rate increase requests are due to rising hospital costs, including increases in hip and knee surgeries, heart procedures and cancer infusion therapies.
• About a third of the rate increase requests are due to rising prescription drug costs - driven largely by high prices for speciality medications and substantial increases in the use of GLP-1 drugs. 

Statement from Excellus BlueCross BlueShield :

As a not-for-profit health plan, Highmark Blue Cross Blue Shield recognizes the financial pressures individuals and small businesses face as healthcare costs rise, and affordability grows as a nationwide issue also affecting energy, housing and food prices.

Our proposed 2027 rates for individual and small group products, which impacts less than 10% of our members, reflect the growing cost of medical care in the communities we serve. This is driven by increased hospital and prescription drug costs, as well as the impact of New York regulatory mandates, taxes, and fees.

With more than 90 cents of every dollar we collect spent on our members' care, Highmark actively collaborates with policymakers, providers, and community partners to address the underlying cost drivers. As part of this effort, we also invest in innovative solutions to expand access, improve health outcomes, and deliver greater value for our members.