Syracuse, NY — Excellus BlueCross BlueShield will raise its premiums by 20.7% next year for individuals who buy coverage through the state’s health insurance marketplace.

Central New York’s largest private insurance company was approved for the second-largest rate increase among insurers statewide. The average rate increase was 7.1% among the dozen insurers on the individual Affordable Care Act-created marketplace.

Excellus acknowledged the difficulty of the steep rate hike, but said it was necessary.

“We know that any increase in costs can be difficult,“ the health insurer said in a statement. ”However, the significant rise in the cost and demand for health care, especially for hospital care and prescription drugs, is impacting health insurers’ premium rates both locally and nationally.”

Roughly 240,000 New Yorkers bought coverage through the individual marketplace last year. Premiums are regulated by the state’s Department of Financial Services.

It’s the second year Excellus has secured a large increase to its individual market premiums. In 2024, the insurer was approved for an 18.3% hike, compared to an average 12.7% hike statewide.

Here are the requested and approved 2026 rate hikes for all insurers in the individual marketplace in New York:

Company NameRequested 2026 Rate ActionsApproved 2026 Rate ActionsAnthem 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%UnitedHealthcare of NY Inc.*36.6%9.1%Average:13.5%7.1%

* Indicates the Company will offer products on the NY State of Health Marketplace in 2026.

Another 685,000 New Yorkers are insured under small-group plans covering employers with 100 members or fewer. Those rates are also regulated.

Excellus won a 15% rate increase in the small-group market for 2026, compared to a 13% average increase for all insurers.

Here are the requested and approved 2026 rate hikes for all insurers in the small group marketplace:

Company NameRequested 2026 Rate ActionsApproved 2026 Rate ActionsAnthem 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%IHBC19.0%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%UnitedHealthcare Ins Co NY23.8%6.8%Average:24.0%13.0%

State regulators echoed Excellus in blaming in-patient hospital stays and rapidly increasing drug prices for the high yearly premium increases.

Insurers were held to a 1% profit provision in the coming year, regulators said.

Nationally, marketplace premiums are expected to go up 18% next year — higher than the New York average, according to the Peterson-KFF Health System Tracker. But that comes a year after rates went up only 7% nationally, lower than the 2024 New York average.

Excellus says the two regulated plans accounted for about 10% of its 1.5 million members.

The regulated rates do not cover state Essential Plan members, Medicare, Medicaid or large employer insurance plans.

Excellus says that 92% of its premiums go back to patient care. The non-profit lost $163 million last year on day-to-day operations, but turned a $25 million profit in 2024 based on investment revenue.

Staff writer Douglass Dowty can be reached at ddowty@syracuse.com or (315) 470-6070.

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