New Yorkers bracing for health insurance premiums in the individual market are in for some unwelcome news as we look ahead to 2024. According to the latest data, individual market rates are set to surge by an average of 12.4 percent next year. Health plans had initially requested a whopping 22.1 percent average rate hike for 2024, but the Department of Financial Services has managed to trim down this figure through New York’s prior approval process.

The table below presents a comparison of the health plans’ original rate hike requests and the rates that were ultimately approved, giving you insight into how the process affects your healthcare costs. (Feel free to refer to our detailed comments on each rate request.)

The prior approval process serves as a critical safeguard; however, the 12.4 percent increase still poses a financial challenge for many New Yorkers. It underscores the need for New York to explore additional measures to protect consumers from steep premium rises outside of the rate review process. States like Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington have already taken steps in this direction, establishing Health Care Cost Containment task forces or agencies.

For those concerned about the affordability of health insurance, there’s some relief to be found. Most New Yorkers purchasing their own health coverage qualify for subsidies that can help offset premium costs. To explore your options and find out more about available subsidies, head over to the NY State of Health enrollment site. If you need assistance with switching plans or enrolling in affordable health insurance, the Navigator program is here to help. Navigators provide free, unbiased enrollment assistance and can help you understand your eligibility for premium assistance and your coverage options. You can reach out Navigators in the CSS Navigator Network at 888-614-5400 or drop them an email at enroll@cssny.org. You can reach out to assistors with the NY State of Health online here or call at 855-355-5777.

2024 Individual Market Rate Changes
Plan	Requested Increase	Approved Increase	Change
Emblem/HIP	52.7%	25.1%	-52.4%
IHBC	39.2%	25.3%	-35.5%
MetroPlus	26.4%	17.6%	-33.3%
CDPHP	23.5%	12.1%	-48.5%
Highmark	22.6%	13.0%	-42.5%
Healthfirst	20.9%	12.5%	-40.2%
UnitedHealthcare	20.9%	12.2%	-41.6%
Anthem (Formerly Empire HealthPlus)	20.7%	8.6%	-58.5%
Oscar	18.4%	7.9%	-57.1%
Excellus	15.2%	12.2%	-19.7%
MVP	13.3%	6.5%	-51.1%
Overall	22.1%	12.4%	-43.9%

Transgender people across the country face discrimination and other barriers to care which can make it difficult to achieve their health care goals. These barriers are there for New Yorkers, too, and came up during a HCFANY-led focus group looking into how LGBTQ+ New Yorkers are affected by medical debt.  Participants described high medical bills after coverage denials for gender-affirming care – despite plans covering these same procedures, like hormone therapy, for cis patients. The discussion also found that LGBTQ+ New Yorkers are still paying out-of-pocket for surprise bills, even as they should be protected under New York’s Surprise Bill Law.

LGBTQ+ New Yorkers should know that they can get support from the State and from advocates if they experience discrimination in the health care system. New York State requires coverage for all gender-affirming treatment and last year required NYS-regulated insurance carriers to develop evidence-based medical necessity criteria for gender-affirming care. All plans are required to submit their criteria to the State for approval and in June the State announced that carriers are complying with the requirements. This is important because it means medical necessity decisions are more standardized and if anything goes wrong, plan members have documentation of what the plan was supposed to do. Until the State required it, many plans had no written policies on gender-affirming care. When they did, their policies didn’t always match medical best practices and categorized necessary treatments as cosmetic.

In its “Health Coverage Information for Transgender New Yorkers” guide, the state describes the process for appealing denials or filing complaints with the state when your rights have been violated. You can also get help from programs like the Community Health Advocates. They can help you no matter what type of insurance you have. Fighting to get health care you need can be exhausting and painful – if you want help, you don’t have to take on the entire burden by yourself.

CHA advocates can also help with the surprise bills that so many focus group participants described. These billing problems included bills that are clearly covered under New York’s Surprise Bill law and receiving multiple bills of varying amounts for one service. One participant received a medical bill that was so unclear she could not find contact information to pay it, even after multiple calls to the hospital where she received care. Another described conversations with their providers’ billing office as feeling “like a tennis ball being bounced around different courts.”  

New York should continue to monitor insurance policies on gender-affirming care and ensure that plans who violate coverage requirements are held accountable. It should also make sure that consumer assistance programs like CHA are fully funded so that patients have support dealing with unclear and unfair medical bills.

Medicare is a life-saver for older Americans, but it does have out-of-pocket costs that can expose some patients to medical debt. A new issue brief created for HCFANY by the Medicare Rights Center explains some of the causes of medical debt for people enrolled in Medicare and describes some steps patients can take to avoid it.

Some of the causes of medical debt for people covered through Medicare are the same as for people with other types of insurance. More and more New Yorkers say they cannot afford to pay for care because of deductibles and out-of-pocket costs. This can be especially difficult for patients who are cannot afford supplemental coverage but are not low-income enough for Medicaid.

Like other patients, people with Medicare deal with medical billing errors and service denials. Patients who have had their care plan denied by insurers are then in a position where they have to ask their doctor for a different care plan; attempt to appeal, which can be overwhelming without help; or pay on their own. Finally, Medicare patients have to navigate covered versus non-covered services. Long-term care, dental care, and even ambulances can leave them on the hook for large medical bills.

Patients with Medicare coverage should review their Medicare Summary Notice to know what bills may be coming and whether any services they’ve received in the past three months were not covered. They can get help with billing questions, appealing service denials, or finding affordable care by calling the Medicare Rights Center at 800-333-4114.

New York State should also do more to protect patients from medical debt. One reason that medical errors are so common and that it is so hard for patients to know what services are covered by what providers is because the current health care system is so fragmented. A single-payer system, like the one that would be created by the New York Health Act, would eliminate the complexity that causes so much distress for patients in today’s system.

New York should also take steps to make medical billing more fair in the current system:

• Funding consumer assistance programs,
• Capping interest rates on medical debt judgments,
• Barring providers from placing liens on patients’ homes or garnishing their wages,
• Banning facility fees, and
• Making the state’s hospital financial assistance policy easier to apply for.

More New Yorkers than ever turned to NYSOH for affordable health coverage at the beginning of 2020. The latest NY State of Health (NYSOH) report shows that 25 percent of New Yorkers (4.9 million) enrolled in health coverage through the NY State of Health during 2020’s Open Enrollment Period.[1] This represents a 150,000 increase over 2019. The report documents enrollment between November 1, 2019 and February 7, 2020. Enrollment through NYSOH has increased every year since it was created, an indication of the need New Yorkers have for health coverage.

Most New Yorkers who used NYSOH enrolled in public plans like Medicaid (3.4 million), Child Health Plus (452,000), and the Essential Plan (797,000). Medicaid and the Essential Plan cover New Yorkers who earn up to 250 percent of the federal poverty level. Child Health Plus covers New Yorkers under the age of 19 with subsidies for families at lower incomes. About 273,000 New Yorkers used NYSOH to purchase private health insurance (Qualified Health Plans or QHPs), 60 percent with financial assistance through premium subsidies. QHP enrollees continued to show a preference for lower-cost options, with Bronze and Silver plans (plans with lower premiums) being the most popular throughout the State. Increasing premium costs are likely the cause of this trend towards lower premium plans, but those lower premiums come with higher deductibles. Even insured New Yorkers report struggling to afford health care – the trend towards enrollment in plans with lower premiums but higher cost-sharing is an important one for advocates to monitor.[2]

Assistors continued to play a key role in the success of last year’s Open Enrollment period, with around 80 percent of last year’s enrollments being conducted by assistors. Navigators, who are trained and certified by the state, are available to provide assistance all across New York – you can find help in your own community by calling 888-614-5400.

NYSOH has proven itself resilient over the years, from the early days when it was unclear whether or not consumers would use it at all through the Trump era when federal policy changes hurt Marketplaces in other states. In the months after this report covers, NYSOH took steps to ensure that New Yorkers were able to keep enrolling in health coverage even as millions lost their jobs or experienced other disruptions during the pandemic. Preliminary data shows that between February 2020 and February 2021, an additional 885,000 New Yorkers used NYSOH to obtain health insurance, and now a record 5.8 million people are enrolled through NYSOH—nearly a third of the state’s entire population.[3] This was only possible because of the investments New York has made over the years towards building a strong, integrated Marketplace where consumers have lots of help available to make the best choices for themselves.

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[1] NY State of Health At A Glance 2020 Open Enrollment Report

[2] New Statewide Healthcare Affordability Survey | Community Service Society of New York (cssny.org)

[3] NYSOH Press Release: NY State of Health Announces Enrollment Surges, More than 5.8 Million New Yorkers Enrolled in Health Coverage