2025 Health Insurance, State of the Union

Are you either unhappy with your agent or unhappy with your current health plan?  If yes, keep reading as there are many upcoming 2025 health insurance changes ahead that your agent/broker should be sharing with you!

There are 2 worlds, Traditional (Obamacare) and Non-traditional health insurance!  See below what’s in store for most of you with Obama Care traditional insurance group and individual plans for 2025:

1. Emblem: (HIP) Formerly known as GHI (Government Health Ins). They removed ALL group policyholders from their “Prime Network” and forced them into what we call the SKINNY “Select Network” in 2024 where it’s hard to find doctors.  Premiums are increasing by 7% in 2025!   NO MORE BROKER COMMISSIONS!  Good Luck getting service directly from Emblem from mostly non-licensed staff!
2. Oxford: They changed their prescription plan in the “Liberty Network” to Broad RX in 2024, and rates are increasing by roughly 5.3% in 2025!  Oxford represents about 70% of the small group (2 or more persons) market.   
3. Aetna: Approved NYS 2025 rate increases of 11.3%.  Aetna ALSO is discontinuing broker commissions as of 1/1/2025.  This leaves the Aetna policyholders exposed with no advocate!
4. Anthem: (Formerly known as Empire Blue Cross) changed their name in NYS after their parent company.  Their rates are increasing by 8% in January 2025!  Anthem is the most expensive NYS carrier because they pay the doctors top dollar!

The definition of insanity is doing the same thing (such as renewing your same health plan year after year) and expecting a different result!!!

There is a whole other world called “Non-Traditional” insurance which offers access to additional networks through partnerships, associations, and unions such as Cigna PPO, Empire “Blue Card” network, PHCS Multiplan network, and Magnacare on a discounted basis. 

It is no secret that the U.S. healthcare system is broken!  See below for my top 6 reasons for this:

1. The USA spends over $12,000 per person per year on health-related issues: This is by far the most in the world.  Other than Germany at $7,500 per person per year, the rest of the world is under $6,000, meaning we spend twice as much per person as the rest of the world!
2. Obamacare Rules and Regulations: Obamacare is “guaranteed issue health insurance,” meaning all applicants are accepted.  Many persons who had no health insurance for years and accumulated health issues were able to secure subsidized plans and “buy a claim!”  Buying a claim is when one has no insurance, buys new insurance, and immediately gets that surgery they have needed for years, then cancels the plan!
3. Dependency on Prescription Drugs: Having been in the life, disability, and long-term care insurance business for over 25 years, it is rare to find someone who is NOT taking prescription drugs.  Because these drugs are expensive, there is a cost share between the insurance company and the policyholder, further driving up costs.
4. The Juvenile Diabetes and Obesity Epidemic: A recent report from the CDC (Centers for Disease Control) projects a 700% increase in Type 2 diabetes for juveniles under age 20 by 2060!
5. Processed Food Label Rules and Bad Habits: We have a national problem with misleading food labels that must be remedied.  There are more than 60 synonyms for sugar, which is found in most baby foods starting the sugar addiction early.  In fact, a NEW WARNING is out from the AAP (American Academy of Pediatrics) on ALL products labeled “Toddler Formula,” saying “Products MAY Contain Too Much Sugar and MAY NOT Provide Adequate Nutrition!”
6. No Market for Individuals: In the current state of health insurance, individuals are doomed!  If someone doesn’t work for a company that offers group insurance or owns a corporation themselves, they are stuck with “Marketplace” options and a 7% price increase for 2025!

As per the NYS Department of Financial Services website, health insurance rates for individuals in NYS will increase by 12.7% on average next year, while small group rates will rise by about 8.4%.

Because of these 6 reasons, health insurance premiums will continue to outpace inflation!

One potential solution is to look at Non-Traditional insurance offered through groups, associations, unions and partnerships!  Some of these plans are medically underwritten, meaning one needs to medically qualify with no pre-existing conditions to get onto the plan.  The benefit is having a much healthier pool of policyholders; hence, reducing claims and smaller percentage future premium increases.

To learn more or get quotes, feel free to email me at Rob@InsuranceDoctor.us.  Let’s hope you never need to use this insurance!