SYRACUSE, NY — Luigi “Lou” Sposito says his small metal fabrication shop in Cayuga County will have less money to spend on pay rises next year when health insurance rates rise 18%.
Spocito, one of the owners of Stonewall Bodies in Genoa, recently learned that his company’s insurance costs could skyrocket in 2023 if the state approved a rate hike request from Excellus BlueCross BlueShield.
The company and its 28 employees split the cost of health insurance 50:50. The increase in premiums will inevitably force some employees to switch to cheaper, less generous, higher-deductible plans that require them to pay more out of pocket for health care, he said.
“We want to be good employers,” said Sposito. “But something like that takes the wind out of your sails.”
New York insurers are targeting rate hikes for two types of customers in 2023.
They want the rate hike up to 46% for small group plans that cover businesses with 100 employees or fewer, such as B. the business of posito. They’re also asking for an increase of up to 35% for consumers who aren’t part of groups and who buy individual plans.
More than 1.1 million New Yorkers are enrolled in small group and individual plans.
The proposed rate hike will not affect large employers, many of which are self-funded, meaning they pay for workers’ medical claims.
Raising is not a bargain. Individuals and businesses affected by the proposals have until August to raise their concerns.
The nationwide average proposed rate increase for individual plans is 18.7%, while the average proposed rate increase for small group plans is 16.5%.
The big proposed rate hike comes at a time when consumers are already grappling with rising prices for gas, food and other commodities. Insurers say the same pressure is also affecting insurers, forcing them to raise rates for more expensive drugs and treatments.
Excellus, the largest insurer in central New York, wants a 6.3% to 18.1% increase for its small group plans.
Excellus is also targeting a rate hike on its various individual plans from 8.3% to 20.1%. The MVP health plan is targeting an increase in its individual plans from 14.2% to 33.8%. Fidelis is calling for a rate hike of up to 34% on individual plans.
These changes affect New Yorkers who are enrolled in the state health insurance exchange, part of Obamacare.
The monthly cost of Excellus’ Standard Platinum plan for individuals sold on the state stock exchange would increase from approximately $1,059 to $1,210, an increase of more than 14%. Platinum plans have the highest monthly premiums, the most generous coverage, and the lowest out-of-pocket expenses.
Approximately 181,000 people in upstate New York, or 12% of Excellus members, are enrolled in individual or small group plans.
The state tax office can approve, reject or reduce the increases. This has significantly reduced the average rate hike rate in each of the last four years. The ministry is expected to announce its decision in August.
The approved rate hike will come into effect on January 1st.
Members of the public can share their views with state regulators about the proposed increase by submitting comments online.
The double-digit growth will weigh on employers and employees at a time when they are facing inflationary pressures, said Daniel Goetzman of Goetzman & Associates, a Syracuse-based health insurance broker.
He expects state regulators to reduce the amount of the increase to a single-digit limit.
According to Excellus, the increase in documents filed with the state is necessary as the cost of healthcare, especially prescription drugs, increases.
Each year the FDA approves a number of expensive new specialty drugs to treat rare and common diseases.
“Specialty drugs are used by about 2 percent of our members, but they account for more than 46 percent of total drug spend,” Axelus said.
These high-priced drugs include heavy commercials for TV drugs like Humira for arthritis and Ozempic and Trulicity for diabetes.
According to the New York Health Plan Association, an insurance trade group, access to health care declined early in the pandemic but has since recovered.
That group said some New York consumers could see their health insurance costs even lower if Congress doesn’t temporarily increase the tax credit. These tax credits have helped lower premiums during the pandemic for New Yorkers who buy insurance on the state health insurance exchange.
More than 138,000 New Yorkers have benefited from increased tax credits provided under the Federal American Rescue Plan Act. When those tax credits expire, premiums for tax-credit-eligible consumers could increase by 58%, according to government data.
Sposito said a big increase in health insurance rates would give his company less money to reinvest in his business and his employees would get a raise.
“It’s like that leaky faucet that you can’t fix,” he said.
James T. Mulder deals with health and higher education. Do you have a news tip? as (315) 470-2245 or . contact [email protected]