Pennsylvania Sees Proposed 2026 ACA Premium Hikes Amid Tax Credit Expiry

Pennsylvania health insurance premiums on the Affordable Care Act marketplace, Pennie, are projected to rise significantly in 2026, with insurers proposing an average 19% increase for individual plans and 13% for small group plans. This increase comes as enhanced federal premium tax credits, which have provided additional financial relief to enrollees since 2021, are set to expire at the end of the year unless Congress acts to extend them. These credits have been instrumental in offsetting costs for about 90% of Pennie's 496,661 enrollees during the last open enrollment period. State regulators, including the Pennsylvania Insurance Department, are currently reviewing these proposed rate hikes and seeking public input by September 2 to ensure the premiums are justified and equitable. Insurers attribute the requested increases to rising healthcare costs, including more frequent use of costly outpatient services and medications, and anticipate that the expiration of enhanced tax credits could lead to a less healthy insurance pool as some healthier individuals might drop coverage. Proposed premium adjustments vary considerably among insurers, with major carriers like Ambetter Health of Pennsylvania seeking about a 30% increase, while one carrier, Partners Insurance Company, is requesting a rate reduction. Despite these hikes, regulators emphasize the marketplace remains competitive with multiple plan options available when open enrollment starts on November 1. This development underscores the ongoing challenges in balancing affordability and coverage sustainability in state ACA exchanges amid fluctuating federal support and healthcare cost pressures.