Syracuse, NY – Excellus Blue Cross Blue Shield to Increase Premiums by 20.7%
Excellus Blue Cross Blue Shield is set to raise premiums for individuals purchasing insurance through the state’s health market by a significant 20.7% next year. This marks the second-largest increase approved among insurers statewide.
As Central New York’s largest private insurer, Excellus’s average increase is notably higher than the overall 7.1% hike among twelve insurers in the individual affordable care market.
While acknowledging the challenges of such a steep rate increase, Excellus stated that the decision was unavoidable. “We understand that rising costs can be burdensome,” the company commented. “However, the substantial increase in healthcare costs—especially hospital services and prescriptions—has influenced premium rates for health insurers in our area and across the country.”
Last year, approximately 240,000 New Yorkers obtained coverage in individual markets, with premium rates overseen by the state’s Department of Financial Services.
This isn’t the first hike from Excellus in the individual market; they also saw a significant increase in 2024, where rates climbed by 18.3%, outpacing the average increase of 12.7% for insurers. For 2026, a variety of rate hikes have been requested and approved across the state’s insurance companies.
| Company Name | Requested Rate Action for 2026 | Approved Rate Action |
|---|---|---|
| Anthem HP, LLC (formerly Empire HealthPlus)* | 10.3% | 4.6% |
| cdphp* | 13.7% | 12.1% |
| Emblem (hip)* | 0.9% | -9.0% |
| Excellus* | 24.8% | 20.7% |
| Fidelis (NY Quality Healthcare Corp)* | 8.1% | 2.9% |
| HealthFirst PHSP, Inc.* | 14.3% | 9.0% |
| Highmark (formerly HealthNow)* | 23.9% | 19.4% |
| ihbc* | 38.4% | 20.8% |
| MetroPlus* | 10.1% | 4.4% |
| MVP Health Plan* | 8.0% | 7.4% |
| Oscar* | 17.0% | 3.5% |
| United Healthcare by NY Inc.* | 36.6% | 9.1% |
| average: | 13.5% | 7.1% |
The company has indicated it will offer products in the New York state health market in 2026.
About 685,000 New Yorkers are also covered under small group plans, which apply to employers with fewer than 100 members. These premiums face similar regulatory oversight.
Excellus is expected to have a 15% increase for small group plans in 2026, in contrast to an average rate increase of 13% for all insurers.
Here’s a glance at the rate hikes discussed for the small group market:
| Company Name | Requested Rate Action for 2026 | Approved Rate Action |
|---|---|---|
| Anthem HealthChoice Assurance, Inc. (formerly Empire)* | 10.9% | 9.7% |
| cdphp* | 22.2% | 22.1% |
| cdphp ubi* | 20.3% | 20.0% |
| Emblem (hip)* | 6.3% | 1.3% |
| Excellus* | 19.6% | 15.0% |
| Highmark (formerly HealthNow) | 18.0% | 11.4% |
| IHBC | 19.0% | 14.4% |
| MVP Health Plan* | 21.5% | 17.9% |
| MVP Health Service Corp* | 15.8% | 15.8% |
| Oxford Health Insurance Inc.* | 28.8% | 11.8% |
| United HealthCare Ins Co | 23.8% | 6.8% |
| average: | 24.0% | 13.0% |
State regulators have criticized hospital stays and have observed that Excellus’s rapid drug price increases contributed to the rise in annual premiums. Interestingly, the insurer is constrained by a 1% profit cap next year, as stated by regulators.
Across the U.S., marketplace premiums are anticipated to rise by 18% in the next year, which is notably higher than the New York average. The Peterson-KFF Health System Tracker hints at this trend. Last year, the New York average increase was more modest, at only 7% nationwide.
Excellus highlights that only two regulated plans account for approximately 10% of its 1.5 million members. It’s worth noting that these regulated fees do not include key state plan members like Medicare, Medicaid, or large employee insurance plans.
Despite having lost $163 million in daily operations last year, Excellus claims that 92% of its premiums are reinvested into patient care. On a brighter note, they reported a profit of $25 million in 2024 from investment returns.
