Pennsylvania Prepares for Significant 2026 Health Insurance Premium Increases
The Pennsylvania Insurance Department (PID) has initiated an educational tour across the state to inform residents about expected significant health insurance premium increases for the 2026 plan year. Health insurers have requested average premium hikes of 19% in the individual market and 13% in the small group market. PID is actively reviewing these requests, scrutinizing plan and regional variations to ensure rate fairness and appropriateness, and will not approve rates deemed excessive, inadequate, or unfairly discriminatory.
These premium increases align with a nationwide trend, where average health insurance premiums are rising by 18%, an 11% increase from the previous year. Rising healthcare costs, increased utilization of costly services and prescription drugs, and the anticipated expiration of the Enhanced Premium Tax Credits (EPTCs) on December 31, 2025, contribute significantly to the proposed hikes.
Approximately half a million Pennsylvanians enroll through Pennie, the state's health insurance marketplace. Currently, three out of four enrollees benefit from EPTCs. Without these credits, premiums could rise by an average of 82%, potentially forcing many consumers to downgrade coverage or forego insurance altogether. This underscores the importance of the policy environment relating to these credits and potential Congressional action.
To assist consumers, PID will conduct free, in-person educational sessions in communities statewide during September and October. These sessions will outline the rate review process, factors influencing premiums, guidance on comparing plan features such as costs and provider networks, and provide tools to help consumers select appropriate coverage during the upcoming Open Enrollment period starting November 1.
Pennie will also engage directly with enrollees, encouraging them to review communications, update account information, and compare plans to manage the anticipated cost changes effectively. The expiration of EPTCs alongside increased premium rates and evolving federal policies highlights a challenging landscape for health insurance affordability and access in Pennsylvania for 2026.
These developments reflect broader market dynamics affecting health insurers, regulators, and consumers, emphasizing the critical role of state regulatory oversight, consumer education, and policy decisions in shaping health insurance markets.