Outside of the exchange, commercial enrollment in New York has fluctuated, with UnitedHealthcare remaining the largest commercial carrier in the state. Highmark's increasing foothold in the state could shake the commercial market dynamics. Plans to increase the use of managed care in the state's Medicaid program should mean enrollment gains for participating carriers. New York's health insurance exchange has seen a robust response among consumers. Exchange premiums are increasing only slightly on average for 2021.