Consumer Choice Continues to be a Hallmark of the Marketplace
ALBANY, N.Y. (March 14, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released data showing 2018 health plan enrollment by insurer. Statewide, 12 health insurers offer Qualified Health Plans (QHP) to individuals and 15 health insurers offer coverage to Essential Plan (EP) enrollees through the Marketplace. Ten health insurers participate in all individual market programs offered through NY State of Health allowing consumers a smooth transition if their program eligibility changes. Throughout the 2018 Open Enrollment Period, most consumers had a choice of at least four health insurer options in every county of the State.
“NY State of Health is proud to offer consumers a robust menu of health plan choices to satisfy the unique, individual needs of our customers,” said NY State of Health Executive Director, Donna Frescatore. “We value our partnership with the health insurer community and appreciate their commitment to providing quality Marketplace products to New Yorkers.”
Qualified Health Plans
Fidelis Care, which offers Qualified Health Plans in all but six counties of the state, has the largest share (41 percent) of total statewide QHP enrollment in 2018 followed by Healthfirst (13 percent) which serves the counties of NYC and Long Island. Four of the five insurers with the highest statewide enrollment in 2018 – Fidelis, Oscar, MVP, and Healthfirst – also had the highest statewide enrollment in 2017. EmblemHealth, which had a 53 percent increase in Qualified Health Plan enrollment this year, is also among the insurers with the highest statewide enrollment in 2018.
2018 QHP Individual Enrollment by Insurer*
Issuer | % of QHP Enrollees |
Fidelis Care | 41% |
Healthfirst | 13% |
Oscar | 8% |
EmblemHealth | 8% |
MVP Health Plan, Inc. | 6% |
MetroPlus Health Plan | 6% |
Excellus BlueCross BlueShield | 5% |
Empire Blue Cross Blue Shield (Medical Downstate) | 5% |
UnitedHealthcare | 3% |
CDPHP | 2% |
Independent Health | 1% |
BlueCross BlueShield of Western New York | 1% |
BlueShield of Northeastern New York | <1% |
Univera Healthcare | <1% |
Empire Blue Cross (Medical Upstate) | <1% |
TOTAL | 100% |
*This chart shows insurers by their d/b/a, or “doing business as,” since they may differ depending on geographic region of the State.
Marketplace insurers each have an approved service area comprising specific counties. Comparing enrollment by insurers’ respective service areas shows significant dispersion of enrollment across plans. No one insurer has more than half of the enrollment in their service area and most insurers have between 6 and 23 percent of the enrollment in their respective service areas, reflecting broad consumer choice of insurers.
2018 QHP Individual Market Share by Insurer *
Insurer | % of QHP Enrollees in Service Area |
Fidelis Care | 42% |
Excellus BlueCross BlueShield | 36% |
Independent Health | 23% |
BlueCross BlueShield of Western New York | 23% |
Healthfirst | 22% |
MVP Health Plan, Inc. | 19% |
MetroPlus Health Plan | 15% |
Oscar | 12% |
CDPHP | 11% |
EmblemHealth | 10% |
BlueShield of Northeastern New York | 6% |
Empire Blue Cross Blue Shield (Medical Downstate) | 6% |
Univera Healthcare | 4% |
UnitedHealthcare | 4% |
Empire Blue Cross (Medical Upstate) | <1% |
*This chart shows insurers by their d/b/a, or “doing business as,” since they may differ depending on geographic region of the State.
The Essential Plan
Fifteen insurers offered the Essential Plan (EP) in 2018 – the same 14 insurers that offered EP in 2017 and one addition, Molina Healthcare, which offers EP in Central NY. Statewide, 22 percent of EP enrollment was with Fidelis Care, 20 percent with Healthfirst, 15 percent with UnitedHealthcare Community Plan, 10 percent with MetroPlus, and the remaining 33 percent were spread across the remaining insurers.
2018 Essential Plan Enrollment by Insurer*
Issuer | % of EP Enrollees |
Fidelis Care | 22% |
Healthfirst | 20% |
UnitedHealthcare Community Plan | 15% |
MetroPlus Health Plan | 10% |
Empire BlueCross BlueShield HealthPlus | 8% |
Affinity Health Plan | 6% |
Excellus BlueCross BlueShield | 5% |
WellCare of New York | 4% |
EmblemHealth Essential Plan - HMO | 4% |
MVP Health Care | 3% |
Independent Health | 1% |
Univera Healthcare | 1% |
YourCare Health Plan a Monroe Plan Company | <1% |
BlueCross BlueShield of Western New York | <1% |
Crystal Run Health Plans | <1% |
Molina Healthcare | <1% |
TOTAL | 100% |
*This chart shows insurers by their d/b/a, or “doing business as,” since they may differ depending on geographic region of the State.
Comparing EP enrollment by insurers’ respective service areas likewise shows significant dispersion of enrollment across plans. Excellus, which provides Essential Plan coverage in a 31-county service area, serving the Southern Tier, Central NY, and North Country is the only insurer with more than 50 percent of EP enrollees in their respective service area. All other insurers have between 4 and 27 percent of EP enrollment in their respective service areas.
2018 Essential Plan Market Share by Insurer *
Issuer | % of EP Enrollees in Service area |
Excellus BlueCross BlueShield | 57% |
Healthfirst | 27% |
Independent Health | 26% |
MVP Health Care | 23% |
Fidelis Care | 23% |
MetroPlus Health Plan | 16% |
UnitedHealthcare Community Plan | 15% |
Univera Healthcare | 15% |
BlueCross BlueShield of Western New York | 12% |
Empire BlueCross BlueShield HealthPlus | 12% |
Crystal Run Health Plans | 9% |
YourCare Health Plan a Monroe Plan Company | 8% |
Affinity Health Plan | 7% |
EmblemHealth Essential Plan - HMO | 5% |
WellCare of New York | 5% |
Molina Healthcare | 4% |
*This chart shows insurers by their d/b/a, or “doing business as,” since they may differ depending on geographic region of the State.
Additional demographic and health plan specific information for the 2018 Open Enrollment Period will be available in the coming weeks.
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Contact: New York State Department of Health
518-474-7354, Ext. 1
About NY State of Health
New York opened its health plan Marketplace, NY State of Health in October 2013. The Marketplace’s one stop health insurance shopping experience offers high quality comprehensive health plans. NY State of Health is the only place where consumers can qualify to get help paying for coverage through premium discounts or tax credits. Eligible New Yorkers can also enroll in Medicaid, Child Health Plus and the Essential Plan through the Marketplace all year. For more information about the NY State of Health Marketplace, please visit: https://nystateofhealth.ny.gov/ or call Customer Service at 1-855-355-5777, TTY: 1-800-662-1220 or find an enrollment assistor.