LEGISLATIVE ROUNDUP: Affordable Care Act 2026 health insurance rates released

Oct. 19--The Pennsylvania Insurance Department (PID) this week released the final Affordable Care Act (ACA) health insurance rates for 2026.

New federal rules on enrollment put in place by the Republican budget bill and Congress's failure to extend enhanced premium tax credits (EPTCs) before Open Enrollment that begins Nov. 1, has resulted in significant price increases for Pennsylvanians.

Without swift action in Washington, Pennsylvania families will face significant increases to their insurance premiums for plan year 2026.

PID and Pennie -- the state's official health insurance marketplace -- have repeatedly urged Congress to extend EPTCs and have sent multiple letters outlining the consequences of inaction on families throughout the Commonwealth.

"These increases are higher than in recent years, even after PID's strong rate review process blocked a number of excessive increases that insurers requested," said Pennsylvania Insurance Commissioner Michael Humphreys. "Soon, Pennsylvanians who purchase their own coverage will be receiving renewal letters from their insurers and from Pennie that will contain prices that will be shocking."

Overall premiums will rise in both the individual market (for people who purchase coverage on their own) and the small group market (for small businesses). The rate adjustments reflect ongoing uncertainty at the federal level along with an increase in medical and drug cost trends and utilization.

Specifically, in the individual market:

--Ambetter Health of Pennsylvania, Inc.: Requested rate increase of 30.1%; approved rate 37.8% due to worsening morbidity.

--Capital Advantage Assurance Company: Requested rate increase of 26.0%; approved rate 24.6%.

--Geisinger Health Plan: Requested rate increase of 14.1%; approved rate 11.6%.

--Geisinger Quality Options: Requested rate increase of 16.2%; approved rate 13.8%.

--Health Partners Plans, Inc.: Requested rate increase of 7.3%; approved rate 16.7% due to worsening morbidity and medical/drug trends.

--Highmark, Inc.: Requested rate increase of 17.2%; approved rate 17.7%.

--Highmark Benefits Group: Requested rate increase of 17.9%; approved rate 18.4%.

--Highmark Coverage Advantage: Requested rate increase of 14.1%; approved rate 14.5%.

--Keystone Health Plan Central: Requested rate increase of 27.9%; approved rate 22.4%.

--Keystone Health Plan East: Requested rate increase of 23.5%; approved rate 22.0%.

--Oscar Health Plan of PA: Requested rate increase of 21.6%; approved rate 23.1%.

--Partners Insurance Company, Inc.: Requested rate decrease of 10.1%; approved rate -10.1%.

--QCC Insurance Company: Requested rate increase of 16.7%; approved rate 15.2%.

--UPMC Health Options, Inc.: Requested rate increase of 11.7%; approved rate 20.2% due to worsening morbidity and federal regulatory changes.

--UPMC Health Plan, Inc.: Requested rate increase of 16.3%; approved rate 24.8% due to worsening morbidity and federal regulatory changes.

What this means for Pennsylvanians

Despite rising premiums, Pennie will continue to offer a range of coverage options, along with financial assistance for those who qualify. No two circumstances are alike. 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.

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.

Pennie's upcoming Open Enrollment period is the only time of year to enroll in individual and family health coverage for 2026. Open Enrollment typically runs from Nov. 1, to Dec. 15, for coverage that starts on Jan. 1, 2026.

DHS highlights research, resources

The Pennsylvania Department of Human Services (DHS) this week released the latest issue of the Positive Approaches Journal, which aims to provide the most recent research for people with behavioral health challenges, intellectual disabilities, autism, and other developmental disabilities to help them live an everyday life.

This edition highlights the role that the environment plays on the everyday lives of people and how fostering supportive environments can promote positive change.

"The Shapiro Administration believes that every Pennsylvanian with intellectual disabilities and autism deserves to receive the supports they need to achieve an everyday life with dignity and opportunity to pursue their goals and live, work, and recreate among their families and peers," said DHS Secretary Dr. Val Arkoosh.

This edition of the Positive Approaches Journal features research and articles on the following:

--"Data insights: This article details how Medicaid-covered home accessibility modifications -- ramps and lifts, widened doorways and hallways, bathroom modifications, specialized electrical or plumbing equipment, and grab bars and handrails -- are important in supporting health, safety, and independence for people with intellectual and developmental disabilities.

--"Designing for Safety -- A trauma-informed approach to environmental design in community-based wellness: This article examines how physical spaces communicate safety, autonomy, and belonging, and how environmental design can play a critical role in resiliency and trauma-informed care for those with intellectual disabilities and autism and those who support them.

--"Creating nurturing environments to support mental health: This article highlights evidence-based techniques to create supportive environments using the Ecology of Human Performance Theory from occupational therapy, which explains the interaction between a person and their environment.

--"Positive impacts of environmental modifications for individuals with autism and dual diagnosis conditions: This article highlights how specified environmental modifications can be implemented in order to best support a person with autism, intellectual developmental disability, and co-occurring mental health needs.

--"Building better lives: Futures Community Support Services, Inc: This article outlines how Futures Community Support Services provides a wide range of individualized services designed to support people with autism or developmental disabilities based on their unique needs and living situations.

--"Transforming lives with technology: This article offers a case study on the balance of an individual's risk and independence in a residential setting."

Meuser announces new communications director

U.S. Rep. Dan Meuser, R-Dallas, announced that Riley Pingree has rejoined his staff as his communications director.

"Riley was a valuable member of our office and communications team in her previous service to our office and we're glad to have her return," Meuser said. "She is a talented communicator and a dedicated public servant for the people of the 9th Congressional District. I am confident she will excel in this new role, leading our efforts to effectively communicate our work on behalf of the district and advance our priorities in Congress."

Before returning to Meuser's office, Pingree served as communications director for U.S. Rep. Tom Kean, Jr., R-NJ. Prior to that, she served as press assistant and later press secretary for Meuser.

A native of North Carolina, Pingree earned a Bachelor of Arts in Communication Studies from the University of North Carolina at Chapel Hill in 2022.

Michelle Stock Mattus, who continues to serve as press secretary and digital director, will support the communications team and assist with day-to-day messaging and press efforts on behalf of Meuser and the constituents of Pennsylvania's 9th Congressional District.

Contact Pingree for all press inquiries at [email protected], or call 202-225-5978.

Reach Bill O'Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.

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