Every year, health insurance carriers that participate in New York’s Marketplace, New York State of Health, submit requests to the Department of Financial Services (DFS) on what they would like to charge for health insurance premiums the following year. See below for template language and instructions for submitting a comment on the proposed 2027 premium increases.

Starting five days after the proposed rates are released, consumers have 30 days to submit comments. DFS considers consumer comments to determine the approved premium changes (typically increases) each insurer is allowed. This process, known as prior approval or rate review, is an opportunity for the State to keep premiums affordable for New Yorkers.

This year, New York’s individual market insurance carriers have asked the Department of Financial Services to allow them to increase premiums by an average of 21% in 2027. This increase would force New Yorkers to pay an average of $2,065 more annually, or $172 more monthly, in premiums. HCFANY hopes the State continues its trend of reducing carrier premium increase requests. For the past three years, the State has approved premium increases of 14% in 2024, 13% in 2025, and 7% in 2026.

Up until July 17th, consumers can make their voices heard by weighing in on the prior approval process.  

Depending on the carrier, premiums could increase by 1% to 52% in 2027, limiting New Yorkers’ ability to spend on other essentials like groceries, transportation, or housing. Below is a table showing the breakdown by carrier.

Make your voice heard: submit a public comment before July 17th, 2026, sharing how steep premium increases would affect your budget or loved ones. Below are the steps and an example script to submit a public comment online.

  • Go to https://myportal.dfs.ny.gov/web/prior-approval/submit-a-comment.
  • Select the following in the drop-down boxes. This information can be found on your insurance card or plan letter notice.
    • The type of plan you have
    • Insurance company
    • Whether you are on an Individual or group policy
  • Fill in your First Name, Last Name, and Contact Information (select one of three options: Email, Address, or Phone number)
  • Write a Comment (Use the example script below if you need help!)
    • Comments can be very short and direct. Every comment helps demonstrate that another member will be harmed if the Department approves the carrier’s current request.

“[insert your carrier’s name] is asking for a [insert from table] % premium increase, which means an annual premium increase of [insert from table]. I cannot afford this. Back-to-back increases in premiums are absurd.

I need health insurance to [insert a reason why you need health care, like affording your prescription drugs, needing to access preventative care, or certain medical services].

At this price, I will be forced to give up [insert reason, such as childcare, groceries, or housing] or forgo health coverage. I urge you to curb these increases and consider how this will impact my family and me.”

_________________________________________________________________________________________________________

Look out for HCFANY’s comments on each carrier’s rate application in the coming weeks.  

New York State of Health (NYSOH) recently announced that cost-sharing reduction programs made possible by the State 1332 Innovation Waiver will continue until the end of 2026. These crucial affordability programs reduced deductibles and eliminated co-payments for outpatient maternity care and out-of-pocket costs for diabetes-related treatments for individuals enrolled in Qualified Health Plans on the individual market. On July 1, 2026, the State will transition from the 1332 Waiver back to the Basic Health Plan, but this will not affect these cost-sharing programs through the end of the year. In addition, this transition will not affect the State’s free insulin program for those with State-regulated health coverage, which was enacted through the State budget in 2024. 

 What is changing? 

In March, New York State of Health announced that the Centers for Medicare and Medicaid Services (CMS) approved New York’s request to terminate its Section 1332 Waiver and return to the Basic Health Plan under Section 1331 of the Affordable Care Act. This transition partially mitigates the impact of HR1, known as President Trump’s One Big Beautiful Bill, enacted on July 4, 2025. The transition will preserve health insurance for 1.3 million New Yorkers but terminates free Essential Plan coverage for 444,000 others. As described on HCFANY’s Protect Health Coverage page, the State could have passed S9589/A10926 to prevent this loss of coverage. 

The State’s cost-sharing reduction program is funded by this 1332 Waiver, and the federal government denied the State’s request to keep funding to maintain these programs for the rest of the year. However, NYSOH just announced that this program will not lapse in July and will continue until the end of this year. HCFANY thanks the State for continuing to protect patients from federal cuts to health care. Data from New York State of Health’s latest enrollment report for 2025 reveals that these three initiatives saved over 62,000 New Yorkers enrolled in Qualified Health Plans around $50 million in health care costs. Based on claims data, these cost-sharing programs have benefited 3,800 with prenatal and pregnancy care, 26,600 with diabetes care, and reduced deductibles for 41,800 with Marketplace Silver plans. You can see the entire list of prenatal and diabetes services here. 

Consumers who have Qualified Health Plans and have a household income between 200% and 400% of the Federal Poverty Level can still enroll in these cost-sharing programs. If an individual is already on a silver plan, they will be automatically enrolled in this program. If the individual would like to switch, they can visit NYSOH and make this change by completing a “Life Status Change” in their application. Some consumers may have received a notice in early June indicating the termination of cost-sharing; they should disregard it.  

What is not changing? 

Fortunately, insulin will remain available to those with State-regulated health insurance with no cost-sharing. New York became the first in the nation to fully eliminate copayments, coinsurance, and deductible requirements for covered prescription insulin by amending the state insurance law in the State’s FY2024-2025 final budget. This new law went into effect on January 1, 2026. Research shows that eliminating co-payments for some chronic care medications—including insulin—generates more insurance claims savings. This law replaced a 2020 statute that had capped insulin copays at $100 per month. The State subsequently eliminated co-payments for maintenance and emergency inhalers in a law that takes effect on January 1, 2027. 

HCFANY hopes the State continues to ensure that New Yorkers have access to affordable, quality care, especially for the half a million New Yorkers who will lose Essential Plan coverage this July due to federal health care cuts. Stay tuned, as HCFANY will review the final budget once it is released. 

HCFANY is thankful to have the opportunity to testify at the 2025 Joint Legislative Budget Hearing on Health. Our fully detailed written comments are here. The Executive Budget includes many proposals to help protect and enhance New Yorker’s access to affordable health coverage. However, the current federal landscape on health care access is uncertain, as proposed cuts to federal health programs could cost the State $10 billion to maintain health coverage for New Yorkers (Learn how these federal threats affect New Yorkers statewide and by Congressional District here).  

The Managed Care Organization (MCO) tax revenue provides an opportunity for the State to ensure New Yorkers have access to and can afford health care. HCFANY urges the Legislature to consider alternatives to the distribution of $1.4 billion of this tax revenue, which currently does not include direct support for patients.  

HCFANY recommends:  

  1. Expanding subsidies for Child Health Plus to eliminate premium cliffs and align coverage start dates to the first day of the month of application.  

This would help ensure that middle-income families can afford their children’s health insurance. Once families surpass the 400% Federal Poverty Level (FPL) income threshold, their children’s annual insurance premiums increase by around $3,000 per child. Additionally, the State should follow similar rules as Medicaid and the Essential Plan for CHP coverage start dates. 

  1. Addressing New York’s expensive health care system.  

New York is ranked second in the nation for the most health care spending per person, and HCFANY proposes three solutions to remedy this: 

  1. Implement an independent New York Office of Health Care Affordability, like the model created in California.  
  1. Include provisions of the Fair Pricing Act (S705|A2140) to ensure consumers and payers are charged a fair reimbursement rate for routine medical services, regardless of where the patient gets care.  
  1. Improve patient outcomes and reduce inequities by including the provision of the Primary Care Investment Act (S1634|A1915A).  
  1. Creating a principal reserve or a rainy-day fund to ensure New Yorker’s access to care is protected from the threats of federal cuts.  

This funding could help keep lawfully present immigrants enrolled in Medicaid covered if the federal government cuts access to health insurance for this population.  

  1. Increasing funding for consumer assistance programs like Navigators and the Community Health Advocates (CHA) program.  

These are only a few initiatives that HCFANY is urging the Legislature to consider, please see our full written testimony here. 

On January 14th, Governor Hochul delivered her 2025 ‘State of the State’ address. HCFANY commends the Governor for proposing sweeping protections for consumers and patients across the State. Her proposals feature many HCFANY advocacy goals falling under six categories: (1) mental health, (2) reproductive health, (3) chronic health conditions, (4) prescription drugs, (5) dental health, and (6) improving insurance coverage. Her proposals plan to:

(1) Mental Health

  • Implement a teen mental health first aid program to equip youth with the ability to respond and address signs of mental health and substance use distress for themselves and their peers.
  • Introduce an initiative that connects youths to critical mental health resources during state-funded after-school programs.
  • Allocate new resources to strengthen compliance oversight and investigate more insurance complaints.

In New York, youth struggling with mental health has been on the rise; in 2023, 48 percent of teens experienced depressive symptoms ranging from mild (27 percent) to severe (11 percent) in New York. Through these proposed initiatives, the Governor hopes to provide basic skills for youths to support themselves and their peers and reduce the impacts of bullying and social violence. Additionally, the State aims to partner with the State University of New York to match social work graduate students with state-funded after-school programs to complete their required fieldwork and support vulnerable youths. 

The current law requires insurers to offer an accessible network of providers, pay at least Medicaid rates for in-network services, and reimburse school-based mental health services at Medicaid rates. Through her proposal, the Governor hopes to improve compliance oversight and investigate and find solutions to mental health care access needs and complaints.

We commend the Governor for her continued commitment to protecting youth mental health and proposing reforms to improve coverage for mental health care.  

(2) Reproductive Health

  • Expand funding for reproductive health care facilities to enable renovations and equipment upgrades to help providers deliver the full range of comprehensive services.

In New York, reproductive health care facilities often lack the proper infrastructure to provide the full range of comprehensive services needed. The Governor hopes to support these facilities through the Reproductive Freedom and Equity Grant Fund and security grant funding to ensure a broader network of providers can deliver quality reproductive health care throughout the State.

HCFANY is excited to see the Governor’s continued effort to ensure New Yorkers have access to reproductive care. Earlier this year, she announced a first-in-the-nation initiative to provide 20 hours of paid leave for prenatal care for privately employed, pregnant New Yorkers, both full-time and part-time.

(3) Chronic Health Conditions

Obesity is a significant concern for New Yorkers; in 2023, around one in three New Yorkers were found to be obese. This chronic condition increases the risk of diabetes, asthma, cardiovascular disease, cancer, and other chronic health conditions. Recently, GLP-1s have transformed obesity treatment, but many face cost barriers to this life-saving treatment. The Governor proposes to provide greater access to GLP-1 drugs for Medicaid members at high risk of cardiovascular events and pressure drug companies to lower prices.

The effects of climate change have increased the severity, duration, and frequency of extreme heat events, also known as heat waves, and these events are deadly for vulnerable populations with chronic health conditions. Heat-related deaths are more likely to occur at home, highlighting the importance of home cooling access. Last year, the Governor implemented an initiative to distribute air conditioners for Essential Plan members whose asthma poses a significant medical risk. Her proposal builds upon this by expanding eligibility to more individuals whose symptoms worsen through these heat events.

HCFANY applauds the Governor’s outstanding support for New Yorkers with chronic health conditions. These initiatives build upon the first-in-the-nation diabetes initiative that HCFANY supported, eliminating co-pays for insulin covered by state-regulated insurance plans, which went into effect this year. As of 2023, 1.8 million New Yorkers have been diagnosed with diabetes, and this initiative is estimated to save eligible New Yorkers up to $1,200 per year totaling around $14 million in 2025.  

(4) Prescription Drugs

The United States spends more on prescription drugs than any other peer country—like Australia, Canada, and France—with prices around two to four times higher for major brand-name drugs. A nationwide survey finds that 82 percent of Americans believe the cost of drugs is unreasonable, and over half of Americans worry about being able to afford their family’s prescriptions. Last year, a bill aiming to implement prescription drug importation program to lower costs (A7954A/S604) was passed in the Senate but fell short in the Assembly. Luckily, the Governor plans to participate in the Food and Drug Administration’s Section 804 Importation Program, which achieves a similar goal in importing low-cost drugs from Canada.

Additionally, the Governor is seeking to introduce a first-in-nation initiative to improve transparency and hold PBMs and drug manufacturers accountable to uncover any unnecessary costs they add to drug prices.

(5) Dental Health

  • Set minimum standards for dental plans available through New York’s insurance marketplace, New York State of Health (NYSOH).
  • Expand the scope of practice for dental hygienists.
  • Direct health plans to improve the availability of dental care.

It is well documented that dental care is essential to oral health, yet many New Yorkers face substantial barriers to accessing essential oral health services. HCFANY is thrilled to see the Governor’s proposal announcing plans to make minimum standards for dental plans available through New York’s insurance marketplace, New York State of Health (NYSOH)—an initiative that HCFANY has been advocating for.

The Governor also aims to introduce legislation to expand the scope of practice for dental hygienists and direct health plans to improve the availability of dental care.

(6) Insurance Coverage

  • Identify and address equity gaps in quality and outcome measurements for those on Medicaid Managed Care plans.
  • Create an integrated care system for Medicaid patients.
  • Perform a comprehensive review of the State’s network adequacy standards and increase enforcement of plan compliance.

In 1994, New York implemented Quality Assurance Reporting Requirements (QARR), which measure and report on health care quality. Though current Medicaid Managed Care (MMC) plans meet or exceed national benchmarks for quality measures, these measurements from QARR cannot identify health inequities within the population. The Governor has proposed to direct MMC plans to analyze gaps in quality and outcomes within their populations, as well as develop strategies to address gaps, including creating a value-based payment.

New York is one of the three states where Medicaid patients can enroll in a separate MMC plan for long-term care along with their medical care coverage, called a partial capitation plan. Many also have separate Medicare coverage. This fragmentation reduces the ability for effective, person-centered, coordinated care. Through her proposal, the Governor plans to work with MMC plans to increase the availability and adoption of integrated care options and limit non-integrated offerings.

Lastly, in New York, network adequacy requirements have not been updated in decades despite variations in health care access across the state. Network adequacy standards require that health plans meet basic standards for members’ access to in-network providers without unreasonable delay or excessive travel. Currently, consumers are often directed to unavailable or out-of-network providers, which leads to untimely care and an increased risk of incurring medical debt. The Governor’s proposal intends to instruct the Department of Health to perform a comprehensive review on network adequacy standards and increase enforcement of plan compliance. HCFANY supports the Governor’s continued investment in proposing initiatives that help protect consumers from incurring medical debt, an issue that HCFANY continues to advocate for.

HCFANY commends the Governor for introducing these initiatives to protect patients and consumers in New York. HCFANY will review the newly released Executive Budget to determine how these proposals will be implemented.