Insurance Department releases 2027 rates

The Pennsylvania Insurance Department (PID) approved 2027 Affordable Care Act (ACA) health insurance premium rates for Pennsylvania's individual and small group health insurance markets. Pennsylvanians who buy health insurance on their own (individual market) will see an average increase of 15.97%, while small businesses (small group market) will see an average increase of 10.28%.

Health insurance companies are required to submit proposed rates to PID before they can take effect. Those filings contain detailed information about what insurers expect to spend on medical care, prescription drugs, and other health care costs in the coming year. PID carefully reviewed those requested rates against supporting data to determine whether the requested rates are reasonable and justified. Through this year's rate review process, PID worked with insurers to update projections when the data did not match PID's analysis, and PID denied $94.7 million in unjustified insurance premium increases.

"Unfortunately, health care cuts by the federal government continue to drive up costs for Pennsylvania families. We understand that these rate increases are rough on Pennsylvania families and businesses, and we fought insurers for every savings we could reasonably assert," said Pennsylvania Insurance Commissioner Michael Humphreys. "PID's rate review process requires insurers to justify every dollar that they propose to charge with data to support the rate. Support for 2027 rates must trend out actual expenses from 2025 and 2026 and reflect expectations for how the 2027 market may differ from 2025 and 2026. Our actuaries pushed back and blocked certain increases totaling almost $95M for Pennsylvanians, while facing realities that saw Pennsylvania's individual and small group market insurers pay $845M more in 2025 medical and prescription drug claims than they paid in 2024—a 13 percent increase in claims costs."

Overall increases in premium rates are being seen across the country and can generally be attributed to rising costs, usage of prescription drugs, and medical care. However, there are additional factors driving up insurance costs. Congress has failed to reauthorize enhanced premium tax credits for 2026 and beyond, causing many individuals to drop coverage and placing increased pressure on medical providers through uncompensated care. Additionally, the July 2025 federal budget law (H.R. 1) added Medicaid work requirements and new enrollment paperwork that will leave many more Pennsylvanians uninsured in 2027. Those people still need care, and the cost of treating them lands on hospitals and on everyone who still pays a premium.

Pennsylvanians who buy their own coverage will see an average aggregate weighted rate increase of 15.97% in the individual market. This is a reduction from the 17.14% originally requested. These increases will vary significantly based on plan type, region, and individual circumstances. Additionally, PID's rate review process reduced the small group average increase to 10.28%, down from initial requests that averaged 11.49%.

Specifically, in the individual market:

Ambetter Health of Pennsylvania Inc: Requested rate increase of 40.9%; approved rate of 35.1%;

Capital Advantage Assurance Company: Requested rate increase of 18.3%; approved rate of 14.8%;

Geisinger Health Plan: Requested rate increase of 10.5%; approved rate of 8.6%;

Geisinger Quality Options: Requested rate increase of 13.0%; approved rate of 10.7%;

Health Partners Plans Inc: Requested rate increase of 15.9%; approved rate of 18.3% (due to less healthy membership confirmed through the federal risk adjustment program);

Highmark Benefits Group: Requested rate increase of 21.4%; approved rate of 19.7%;

Highmark Inc: Requested rate increase of 16.2%; approved rate of 14.5%

Keystone Health Plan Central: Requested rate increase of 33.8%; approved rate of 33.4%;

Keystone Health Plan East: Requested rate increase of 14.7%; approved rate of 16% (due to worsening medical and drug trends);

Oscar Health Plan of PA: Requested rate increase of 15.4%; approved rate of 1.4%;

Partners Insurance Company Inc: Requested rate increase of 20.5%; approved rate of 18.8%;

QCC Insurance Company: Requested rate increase of 19.9%; approved rate of 21.3% (due to worsening medical and drug trends);

UPMC Health Network Inc: Requested rate increase of 12%; approved rate of 9.7%; and

UPMC Health Plan Inc: Requested rate increase of 15.8%; approved rate of 13.5%.

Pennsylvanians Should Prepare to Shop Around on Pennie

The average rate increase is different than the amount each consumer will pay in premium. Pennie will continue to offer a range of coverage options, along with financial assistance for those who qualify. No two circumstances are alike. One Pennsylvanian may see premiums decrease, while another may see an increase – even if both purchase coverage through Pennie. Factors such as age, location, household income, family size, and market competition all affect what someone pays and what level of subsidy they may receive.

"At Pennie, we've heard from Pennsylvanians in every county about how essential high quality, affordable health coverage is both for life-saving care and protection from medical bankruptcy. We know that the end of the enhanced premium tax credits has put many across Pennsylvania in extremely difficult positions," said Devon Trolley, Executive Director of Pennie. "Again this year, however, Pennie will be here to provide up-to-date information and support about plan costs and options for 2027. All current Pennie enrollees should update their information and review their 2027 plan options during Pennie's Open Enrollment Period, starting this November."

Most Pennsylvanians will continue to find the lowest prices and financial savings through Pennie, the state's official health insurance marketplace. Only Pennie offers financial assistance to help lower monthly premiums and out-of-pocket costs.

All plans on Pennie include important consumer protections:

Coverage for pre-existing conditions;

Essential health benefits like preventive care, prescriptions, and hospital visits;

Limits on what you pay each year and protection against emergency care cost; and

Multiple plan levels (bronze, silver, gold, platinum) and network types (HMO, EPO, PPO) with different coverage options.

Pennie's upcoming Open Enrollment period is the only time of year to enroll in individual and family health coverage for 2027. Open Enrollment typically runs from November 1 to December 15for coverage that starts on January 1, 2027. Outside of Open Enrollment, only individuals with life changes (such as losing coverage from Medicaid and family events) can enroll.

Pennie offers free help by phone and in-person across the state. Visit pennie.com or call 1-844-844-8040 for assistance.

Consumers with questions or complaints about their health insurance can visit pa.gov/consumer or call 1-866-PA-COMPLAINT (1-866-722-6675).

Visit PID's website for more details about the ACA rate filings.

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