Bloomfield woman says promised deductible cut not honored after Essential Plan changes
Mon, July 27, 2026 at 7:16 PM
UpdatedMon, July 27, 2026 at 7:18 PM
WHAM
Rochester, N.Y. (WHAM) — A Bloomfield woman is seeking answers after she says a promised reduction to her health insurance deductible was never applied, leaving her responsible for thousands of dollars in additional medical costs
Lorri Anne Newman is among roughly 450,000 New Yorkers affected by changes to the state’s Essential Plan following federal funding cuts
“I was on the Essential Plan with the New York State of Health, and we were notified that the Essential Plan was no longer and it would expire on June 30,” Newman said
Under the Essential Plan, Newman paid no monthly premium and had no deductible. Her new health insurance plan costs $464 a month and carries a $10,600 deductible
“Oh, it hurts. It hurts a lot,” Newman said. “We’re putting stuff on credit cards, myself and my husband.”
Newman said she is disabled and has several health conditions. Her husband is retired and has back problems, leaving the couple on a fixed income
According to Newman, Excellus BlueCross BlueShield told her in a May 18 email that her premium would be prorated and her deductible reduced by half because her new coverage began midway through the year
However, she said the $10,600 deductible has not been adjusted. “As of today, they have not reduced the deductibles, and Excellus is pointing their fingers at the New York State of Health,” Newman said. “The New York State of Health is saying, ‘We have nothing to do with the deductibles.’”
Newman said she has already incurred nearly $8,000 in costs that count toward the deductible. That is approximately $2,700 more than the $5,300 deductible she said she was promised for the second half of 2026
She is also concerned about how she would recover money paid beyond the promised amount. “There is no plan in place for people that are in my situation to get reimbursement,” Newman said. “I have to go to the individual hospitals or pharmacies or doctors to get reimbursement for anything above and beyond the deductible that I’m supposed to be paying.”
Excellus BlueCross BlueShield said it could not discuss Newman’s case because of federal privacy laws, but released a statement to 13WHAM:
Earlier this year, New York State of Health adjusted program requirements and eligibility guidelines affecting certain Essential Plan members. We are monitoring evolving state guidance for how to administer these changes.
We know these changes may create uncertainty and raise questions about health coverage and eligibility. We are actively working to provide clear information, support members through the transition, and help consumers understand the coverage options available to them.
Due to federal privacy laws, Excellus BlueCross BlueShield (Excellus BCBS) cannot comment on individual situations.
The most up to date information can be found at New York State of Health | Health Plan Marketplace for Individual and Small Business Health Insurance.
“So I have to pay this all out of pocket until somebody figures out how to fix this,” Newman said
The New York State Department of Health released a state saying:
The Department is committed to supporting New Yorkers who have lost their Essential Plan coverage as a result of the impact of federal HR1 legislation on New York’s 1332 State Innovation Waiver. This is a challenging time for those impacted by the new laws. We are committed to providing personalized guidance to these New Yorkers as they transition to new plan options through our enrollment assistors, ensuring advance notices and providing resources and information to make the path to new coverage as clear and as smooth as possible.
As part of the transition, New York State of Health asked insurance companies to prorate deductibles and out-of-pocket costs for consumers moving from the Essential Plan to Qualified Health Plan coverage for the July-through-December 2026 period. The department said five insurers elected to prorate those costs
State officials said consumers should work directly with their insurance companies to confirm the terms of any cost-sharing reductions. The department said it could not comment on the specifics of Newman’s coverage
New York State of Health has trained enrollment assistors to help affected consumers find new coverage and has provided those assistors with reports identifying consumers who may need assistance. The marketplace’s customer service center is also helping consumers, although the state said call volumes have been high since outreach began in April
As of July 9, the state said roughly half of consumers between 200% and 250% of the federal poverty level who lost Essential Plan coverage had enrolled in another plan through New York State of Health. That includes people who became eligible for Medicaid, qualified for the Essential Plan under its new income limits or selected a Qualified Health Plan
“This is a hardship, but I’m doing OK,” Newman said. “But I think of a single mother who has children and is trying to work and trying to navigate this.”
Affected members have until Aug. 30 to enroll in a plan through New York State of Health. The Department of Health said it plans to release a complete set of enrollment data after the special enrollment period ends
Excellus BCBS encouraged consumers with questions about eligibility or available coverage to contact New York State of Health. Excellus members seeking assistance can call 1-888-264-4509, or TTY 711
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