Medical/Rx Benefits

New York Medical/Rx Benefits Benchmarks

Real plan data from verified employers in your state

Verified Data
1,144Employers
3,715Plans
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Source-verified plan dataReal plans, not surveysRefreshed monthly
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Employee Benefits in New York

Medical plan benchmarks from verified employer data

Verified Data

Medical benefits typically represent the largest share of employer benefit spending and are a key factor in employee recruitment and retention.

Our database includes 1,144 employers in New York offering 3,715 verified benefit plans. PPO plans are the most common (37% of employers), followed by HDHP (35%). Funding approaches are mixed, with fully-insured (60%) and self-insured (30%) both common. Most employers offer three or more plan options to employees (65%).

Medical plan benchmarks include deductibles, copays, coinsurance, out-of-pocket maximums, and employer contribution rates.

1,144 employers3,715 verified plansUpdated September 2026
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New York plan design & cost benchmarks

In-Network Cost Sharing — sample layout
In-Network Benefits
LimitedBalancedRobust
Your Plan
Individual Deductible
$584
$1,501
$2,880
$1,50152Bal
Family Deductible
$1,000
$2,786
$5,552
$2,78652Bal
Individual OOP Max
$3,582
$4,496
$6,245
$4,49652Bal
Family OOP Max
$6,192
$10,394
$12,605
$10,39452Bal
Coinsurance
12%
18%
28%
18%52Bal
Primary Care
$25
$37
$48
$3752Bal
Specialist
$35
$60
$70
$6052Bal
Emergency Room
$205
$329
$456
$32952Bal
Urgent Care
$52
$71
$91
$7152Bal

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Real plan-design and cost benchmarks for new york, with percentile rankings and exportable data.

What's inside the full report
In-Network Cost Sharing

Deductibles, copays, coinsurance & out-of-pocket maximums

Employee Contributions

Monthly employee premium contributions by tier

Gross Premium Rates

Total monthly premium costs by coverage tier

Prescription Drug Coverage

Rx copays, deductibles & mail-order options

Percentile rankings (25th / 50th / 75th)
Live, real-time data (this preview refreshes monthly)
Exportable to PDF & CSV

Plan Type Mix

% of employers offering each

VERIFIED
PPO37%
HDHP35%
EPO16%
HMO8%

Plan Funding

% of employers by funding

VERIFIED
Fully-Insured60%
Self-Insured30%
Level-Funded10%

Plans Offered

% of employers by plan count

VERIFIED
Three or More Plans65%
Two Plans24%
One Plan11%
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See What You'll Discover

Our reports reveal exactly where your plan stands, and why. Preview using sample New York data.

72
Balanced
Sample Report
Sample PPO Gold 1500
Blue Cross Blue Shield · PPO

This plan aligns well with common market practices. Benefits and costs are competitive, providing reliable value that meets typical employer offerings in your segment.

Based on 847 comparable plans
Core Scoring Drivers
In-Network Cost Sharing78Robust

Deductibles and copays rank above market median, offering strong value to employees.

Employee Contributions65Balanced

Contribution levels are competitive with peer employers in your industry.

Premium Rates71Balanced

Gross premiums align with market expectations for comparable coverage.

Plan Types
PPO
42%
HDHP
31%
HMO
18%
POS
9%

% of employers

Plans Offered
2 Plans
38%
3 Plans
29%
1 Plan
22%
4+ Plans
11%

% of employers

Funding Types
Fully Insured: 58%
Self-Funded: 34%
Level-Funded: 8%
Top Performers

Features in top 25% of peers

Individual Deductible82Robust
In-Network Cost Sharing
Primary Care Copay79Robust
In-Network Cost Sharing
Generic Rx Copay77Robust
Prescription Drugs
Individual OOP Max76Robust
In-Network Cost Sharing
Under Performers

Features in bottom 25% of peers

Family Premium18Low
Gross Premium Rates
EE+Spouse Contribution21Low
Employee Contributions
Specialist Copay24Low
In-Network Cost Sharing
Actionable Insight

Family Premium ranks in the 18th percentile. Adjusting employer contribution strategy could improve retention without significant cost increases.

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New York Benefits Landscape

Regional trends and benchmarking considerations

New York employers operate in one of the most heavily regulated state insurance markets, with community rating requirements and mandated benefits that influence plan design. Our benchmarking data shows New York employers face significantly higher premium costs than national averages. Employer contribution strategies often absorb more of this cost to remain competitive for talent.

Key Highlights

Highest Premium Costs

New York consistently shows the highest or near-highest gross premium rates in our national database, driven by state regulations and healthcare market dynamics.

Generous Employer Contributions

To offset high premiums, New York employers typically contribute above-average percentages, particularly for employee-only coverage.

Regulatory Complexity

State-mandated benefits and community rating rules limit plan design flexibility, resulting in more standardized offerings across employers.

Benchmarking Considerations

New York benefits reflect the state's unique regulatory environment. Financial services and healthcare employers typically offer richer plans than other sectors. Use industry filters to find relevant comparisons.

Frequently Asked Questions

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