The New York State Department of Financial Services has released their approved 2016 plans and rates for health insurers operating in the state.

Most health insurance companies had requested substantial rate increases for 2016 (including the federal government’s non-profit or “Co-Op” carrier, Health Republic), which for the most part were approved by the NYS DFS. Below you will find the list of carriers, requested rates, and DFS-approved 2016 rates, which is broken down by individual and small group business. Bear in mind that these rate adjustments are represented in overall percentages, as individual plans and rates will vary:

Small Group Market Plans/Carriers

Aetna Life: 23.87% 21.47%*
CDPHP HMO: -19.84% -19.84%
CDPHP UBI: 16.56% 16.56%
Emblem HIP: 29.74% 29.74%*
Empire Assurance: 8.70% 3.40%
Empire HMO: 9.21% 4.37%*
Excellus: 13.90% 10.00%
Health Republic: 20.00% 20.00%*
HealthNow: 8.06% 0.66%
Independent IHA: -15.60% -15.60%
Independent IHBC: -6.19% -6.19%
Managed Health: 5.60% 3.94%
Metro Plus: -0.81% -0.81%
MVP Health Plan: 7.28% 6.36%
MVP Services: 16.71% 15.90%
North Shore LIJ: 3.27% 3.27%*
Oxford OHI: 13.61% 6.75%*
Oxford OHP: 10.58% 3.90%*
United UHIC: 18.79% 11.61%

*Carriers writing plans in downstate New York/Long Island

Individual Market Plans/Carriers

Affinity: 6.63% 6.63%*
CDPHP HMO: 5.69% 2.52%
Emblem HIP: 13.20% 10.51%*
Empire HMO: 14.50% 13.20%*
Excellus: 12.80% 5.72%
Fidelis: 4.66% 4.66%*
Health Republic: 14.36% 14.03%*
HealthFirst: 12.89% 9.60%*
HealthNow: 6.68% -1.32%*
Independent: -10.36% 10.36%
Metro Plus: -7.00% -7.00%*
MVP Health Plan: 13.48% 10.24%*
North Shore LIJ: 4.93% 4.43%*
Oscar: 4.54% 4.54%*
Oxford OHP: 5.32% -12.25%*
United: 22.00% 1.65%*
Wellcare: 4.71% -3.30%

*Carriers writing plans in downstate New York/Long Island

2016 Downstate New York Analysis

Small Group Market

-Oxford’s OHI and OHP plans continue to provide expansive local and national in-network coverage for small businesses. With traditionally average rate increases of 6.75% and 3.90% respectively, Oxford should remain a solid player in the downstate NY small group market for business owners who wish to stay with a larger provider network, and optionally, PPO access.

-With Aetna’s 21.47% increase, expect many businesses to move over to Oxford for group health coverage (those business owners who wish to remain with a large provider network that is).

-For businesses that switched over to narrow provider network-based carriers in 2014 and 2015, BIG changes are coming for 2016. Where Health Republic once offered a great alternative to Oxford and Aetna group plans, expect to see these business owners quickly abandon ship due to a 20% rate increase next year.

-Emblem previously scaled down their EPO network to their new smaller “SelectCare” network, putting them in the narrow network category. With a 29.74% rate increase coming next year, most business owners will not recognize Emblem as a competitive coverage option.

-North Shore LIJ (now known simply as “CareConnect”) continues to build on their high quality, narrow network service model. Having recently added new hospitals to the network in Eastern Long Island, NYC, Westchester, & Connecticut, and along with their modest 3.27% rate increase, CareConnect will be the “go to” narrow network carrier for most small groups in downstate New York…especially in Queens and most of Long Island.

Individual Market

With the exception of the Medicaid-space (extremely narrow network) carriers offering qualified health plans on the NYSOH exchange (Fidelis, HealthFirst, Affinity), most downstate individual market carriers requested substantial rate increases for 2016. While this comes as no surprise, the following should be noted:

-Oxford Liberty HMO plans will see a dramatic rate reduction (-12.25%) for 2016. With such a drastic reduction in price, something will have to give. Existing Liberty HMO customers should expect an announcement from Oxford in the coming months regarding provider network changes/scale downs for 2016.

-For the second year in a row, Health Republic customers can expect a large rate increase upon renewal. For 2016, the overall approved rate increase is 14.03%. With Oscar and CareConnect’s combined 2016 rate increase of about 4.5%, expect many Health Republic customers to move over to Oscar or CareConnect plans next year.

-With no expansion of Emblem’s “SelectCare” network or Empire’s “Pathway” network (both which are narrow), consumers will likely find no value in their 2016 plans in lieu of their 10.51% and 13.20% respective rate increases.

-United Healthcare customers will see a mere 1.65% rate increase come renewal time. With an announcement (hopefully) coming soon from the carrier indicating their Compass network is in fact national, UHC customers will find good value in their plans for 2016, and (if announced) will be the only carrier in downstate NY offering national in-network provider access.

Specific plans and pricing for 2016 will become available from the carriers over the next month or so. As we receive this information, we will follow up with another post.

For more information about individual or small group health insurance in downstate New York or in Long Island, contact an insurance broker.