Pennsylvania Health Insurance Premiums Set for Significant Increase in 2026

Pennsylvania's health insurance premiums are projected to rise significantly in 2026, with carriers proposing average increases of 19% for individual plans and 13% for small business groups on the Pennie marketplace, the state's Affordable Care Act exchange. These proposals are under review by the Pennsylvania Insurance Department, which seeks public input until September 2 to evaluate the fairness and adequacy of the rate adjustments. The state's Insurance Commissioner encourages consumers to compare plans carefully amidst these changes.

Enrollment on Pennie reached a record 496,661 last year, with approximately 90% of enrollees benefiting from premium tax credits that lower monthly costs based on income. However, the enhanced premium tax credits introduced in 2021 are set to expire after this year unless Congress renews the funding, potentially impacting affordability for many.

Insurers attribute the requested premium hikes to rising healthcare costs overall, alongside increased utilization of costly outpatient services and medications. They also highlight concern that the loss of enhanced tax credits could lead some healthier individuals to forgo coverage, resulting in a sicker insurance pool that is more expensive to cover.

Requested premium increases vary significantly between insurers; for instance, Ambetter Health of Pennsylvania seeks a 30.1% rise, Capital Advantage Assurance 26%, and Keystone Health Plan East 23.5%. Conversely, Partners Insurance Company proposes a 10.1% decrease in certain regions. This diversity reflects differing risk pools and market strategies within the state.

Despite these upward adjustments, the Pennsylvania Insurance Department points to a competitive ACA marketplace that should still offer consumers multiple plan choices at varied price points when open enrollment starts November 1. The department's review process emphasizes preventing excessive or discriminatory premium changes while maintaining market stability.

Stakeholders are advised to monitor regulatory outcomes and prepare for potential shifts in insurance participation and pricing dynamics next year. The evolving landscape underscores the interplay between federal policy on premium tax credits and state-level regulatory oversight in shaping Pennsylvania’s health insurance affordability and accessibility.