Buffalo, N.Y. (WBEN) - Open enrollment is set to get started in New York for Affordable Care Act (ACA) plans starting Saturday, Nov. 1, 2025 and is slated to remain open until Thursday, Jan. 15, 2026.
While the open enrollment period has yet to commence, healthcare benefits expert Brian Faraci with The Financial Guys says it's already been a whirlwind, with a ton of changes happening in Western New York and across the country when it comes to Medicare.
"Specifically here for Western New York, we're seeing several plans being discontinued, spread out over a couple different insurance carriers. Highmark, Independent Health have been the hot topic as of late due to HMO plans not being accepted at Roswell Park starting in January 2026," noted Faraci in an interview with WBEN. "We're seeing a lot of disruption in that regards."
According to analysis from the consulting firm Mercer, employers are bracing for the highest health benefit cost increase in the last 15 years, which may create some sticker shock for some signing up for healthcare benefits this upcoming year.
Where Faraci feels the sticker shock will be felt with increases in copays and premiums, but the biggest change is likely to be seen with deductibles on people's medications.
"They passed the Inflation Reduction Act last year or two years ago, which put a cap on all medications for Medicare recipients at $2,000. Well, that's already gone up $100 to $2,100, is the new max for 2026, but they've also increased the deductibles on your medication," Faraci noted. "If you have a brand name medication or high price med, you can expect to pay an additional up to $615 more in the beginning of the year before your insurance kicks in any payments."
According to Mercer's estimates, the total health benefit cost per-employee is expected to rise anywhere between 6% and 7% in 2026, even after accounting for planned cost-reduction measures. While that's similar to what Faraci has seen, he's even seen some higher projected increases from insurance carriers.
"They sent their proposals to the state over the summer, and some of the insurance carriers were asking upwards of a 28% increase. We know the state's not approving that large of an amount, but I would say we're probably looking at anywhere between 6%-7%, even as high as 12%-to-14% with some insurance carriers, which puts a big damper on to small businesses," Faraci noted. "It's difficult when you're offering all these benefits to your employees, and now you have additional overhead in that cost. And then that's a trickle down effect to the employee, who's got to contribute part of their paycheck to their health insurance. So it's affecting everyone across the board, and it's making it very difficult with the cost of everything else going up as well, as we see - car insurance, home insurance, groceries, everything is going up."
Faraci wishes he could point to one sole reason for such an increase, but he says everyone is involved in the rate hikes.
"It's the government, it's the Centers for Medicare and Medicaid, it's the insurance carriers, the doctors, the hospitals. The cost goes up with one of those, and then you see the trickle down effect, where the pharmaceutical companies now have to raise their cost, and now the insurance carriers have to get creative and move around different things to offset the cost of the cap on medication," he explained. "That's why you're seeing some of the plans discontinued and the deductibles going up. I would foresee this going up the next couple of years before we see any drastic change with these premiums going down, if at all ever."
Related
