With the arrival of the new year, several new regulations in New York State have come into effect as of January 1st, many of which directly impact healthcare insurance and the cost of living. The state government has indicated that these legislations aim to alleviate the financial burden on residents when it comes to medical expenses and to enhance basic health coverage. However, insurance companies have issued warnings, stating that the continued increase in mandatory benefits could potentially drive up overall premium costs.
The New York State Assembly passed over 850 bills during its 2025 session, with some of these laws officially taking effect at the start of the new year. Governor Hochu emphasized that the focus of the new laws is on improving affordability to prevent individuals from delaying necessary medical treatments due to exorbitant healthcare costs. She underscored that residents should not be forced to choose between maintaining their basic livelihood and bearing life-saving medical expenses.
Among the various new regulations, those pertaining to healthcare have garnered significant attention. Firstly, concerning the EpiPen, a commonly used auto-injector for severe allergic reactions, New York State now mandates that health insurance plans have a yearly cap of $100 on co-pays for this medication. The state government pointed out that the device had previously reached a price of up to $600 for a pack of two, placing a heavy burden on patients. This new regulation was legislated in 2024 and has now officially taken effect this year. However, the cap does not apply if the policyholder is enrolled in a high-deductible insurance plan and has not yet met their deductible threshold.
Furthermore, the state government has also concurrently pushed for expanded coverage related to cancer. Another law set to take effect in 2026 requires insurance companies to comprehensively cover breast cancer screenings and diagnostic imaging based on international clinical guidelines, including diagnostic mammography, ultrasounds, and MRI scans, while limiting the proportion that patients must cover themselves.
The third healthcare regulation focuses on the quality of cancer treatments. New York State will now require large group insurance plans to cover “scalp cooling therapy,” a technique that reduces the impact of chemotherapy on hair follicles, thereby minimizing hair loss. Although this treatment has already received approval from the U.S. Food and Drug Administration and has been included in federal health insurance and Medicaid systems, many private insurance plans do not currently cover it, leaving patients to often pay thousands of dollars out of pocket.
In response to these developments, the insurance industry has expressed concerns. The New York State chapter of Blue Cross Blue Shield noted that the existing mandatory benefit requirements for health insurance in the state already exceed 70 items, and each additional mandatory benefit will ultimately be reflected in overall premium costs. Industry players believe that the cumulative long-term effects may exert unsustainable cost pressures on individuals and small to medium-sized businesses.