Relative Cost of Coverage
At $820 per month, New York’s average Bronze premium is the 2nd highest among the 50 states—above New Hampshire (the least-expensive state with an average premium of $273) and below Vermont (the most-expensive state with an average premium of $854).
Because New York’s average premiums are much higher than the U.S. average and incomes are slightly higher than the U.S. median, the premium represents 12.1% of median household income—significantly higher than the national average of 6.3%.
| Avg Premium | Premium / Household Income | |
| New York | $820 | 12.1% |
| United States | $425 | 6.3% |
Variation Within the State
Within New York, average Bronze premiums for a 30-year-old range from about $627 to $914—a roughly 1.5-to-1 swing. But those numbers matter most when weighted by where people actually live:
| New York’s Population Pct | Below this Average Premium | Counties |
| 25% | $722 | Fulton, Oswego |
| 50% | $746 | Hamilton, Lewis |
| 75% | $816 | Clinton, Tompkins |
- One-quarter of New York residents live in areas where the average 30-year-old Bronze plan is $722 or less, and three-quarters live where it’s $816 or less.
- The lowest average Bronze premiums for 30-year-olds are typically found in counties such as Allegany ($627), Cattaraugus ($627), Chautauqua ($627), often clustered in western New York.
- Conversely, the highest average premiums are often seen in counties like Rockland ($914), Putnam ($898), Sullivan ($898), which lie in the Lower Hudson Valley region.
- In Kings, the state’s most populous county, the average Bronze premium for a 30-year-old is $877.
Variation by Age
| Age | Average Bronze | Average Silver | Average Gold |
| 21 | $819 | $1,054 | $1,275 |
| 30 | $820 | $1,054 | $1,279 |
| 40 | $820 | $1,054 | $1,279 |
| 50 | $820 | $1,054 | $1,279 |
| 60 | $820 | $1,054 | $1,279 |
In New York, individual-market plans are subject to pure community rating, which prohibits any premium variation by age, gender, health status, or other risk factors. Unlike the Affordable Care Act’s 3:1 age-rating cap, New York law outright bans age-based pricing, so 21-year-olds and 60-year-olds pay the same amount for the same metal tier. This uniform rate structure spreads risk evenly across all enrollees but shifts a larger share of costs onto younger people—meaning employers with predominantly young workforces may find New York’s individual-market coverage relatively less affordable.
The Role of Premium Tax Credits
Premium Tax Credits (PTCs) limit the share of household income that is spent on a marketplace plan.
They equal the difference between (a) the premium of the benchmark Silver plan for an employee’s age and county and (b) a sliding-scale contribution tied to household income. Because benchmark premiums rise with age, PTCs rise more or less in step; because the required contribution shrinks as income falls, credits grow even faster for lower-paid workers.
When a company offers affordable coverage—whether through a group plan, an ICHRA, or a QSEHRA—the employee forfeits the credit. If the employer’s benefit isn’t meaningfully higher than the federal subsidy it replaces, neither the business nor the worker comes out ahead. In practice, we’ve found that when most employees qualify for about $200 or more per month in PTCs, an employer-funded plan rarely delivers additional value.
For New York, that $200-mark is reached at roughly $25,000 of wages for a 30-year-old and about $25,000 for a 40-year-old. If most of your team sits above those thresholds, consider skipping an affordable plan—or design an HRA that is affordable for higher-paid staff but intentionally unaffordable for lower-paid or older employees, letting each person keep whichever option (company benefit or federal credit) leaves them better off.
Why HRAs Usually Outperform Small-Group Insurance
For most small employers in New York, reimbursing individual-market premiums through an ICHRA or QSEHRA offers clear advantages over buying a traditional group contract:
- Lower structural cost – Individual carriers must meet an 80% medical-loss ratio, publish rates, and pay lower commissions; small-group carriers face looser caps and higher commissions, which show up in premiums.
- Employee choice and portability – Each worker selects the network, deductible, and metal tier that fits their situation and keeps the policy when changing jobs.
- Budget control – Employers set a fixed allowance. Marketplace premiums move predictably, avoiding double-digit renewal shocks common in the group market.
- Simpler compliance – HRAs eliminate participation minimums and most COBRA or Form 5500 obligations, and they are just easier to administer.
Run the Numbers for Your Team
Salusion makes it easy to estimate healthcare costs.
Simply enter an employee’s age, zip code, and annual salary into Salusion’s Cost-of-Insurance Calculator, and instantly see average premiums for Bronze, Silver, and Gold individual plans. The calculator also provides an estimated premium tax credit based on the entered household income, and will also tell you whether a proposed HRA allowance is considered affordable for an ICHRA and a QSEHRA.
