PA Health Insurance Rates To Soar In 2026

Pennsylvanians who purchase health insurance through the state's Affordable Care Act marketplace, Pennie, face rate increases of up to 37.8 percent in 2026, according to final rate approvals released Tuesday by the Pennsylvania Insurance Department.

The final rates, which were approved ahead of the start of the Nov. 1 open enrollment period, show premium increases ranging from 11.6 percent to 37.8 percent for the individual and small group markets. One plan, Partners Insurance Company Inc., will see a 10.1 percent decrease, per data released by state regulators.

State insurance officials attribute the "significant price increases" to the effects of new rules from the federal Big Beautiful Bill Act and Congress' failure to extend enhanced health care tax credits, one of the issues that has led to the current federal government shutdown.

The increases could translate into large premium spikes for some consumers.

As an example, state regulators said a 60-year-old married couple in York County with an annual income of $82,000 will see their yearly premium jump from $7,032 to $35,712.

"These increases are higher than in recent years, even after [the Pennsylvania Insurance Department'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."

The rate adjustments also reflect nationwide trends, including rising medical and drug cost trends, increased utilization, and ongoing uncertainty at the federal level.

The state insurance department noted that Congress has the power to act immediately, which could reduce insurance rates by 3 percent to 5 percent if the enhanced premium tax credits (EPTCs) are extended, but that "time is running out."

"We know that the end of the enhanced premium tax credits will put many across Pennsylvania in extremely difficult positions," said Devon Trolley, executive director of Pennie. "Throughout these changes, Pennie will be here to provide up-to-date information and support about plan costs and options for 2026."

Insurance companies that operate on the Pennie marketplace annually submit requests for premium changes, which state regulators review to see if they are "reasonable and properly supported.".

The approved 2026 rate changes for the individual market are:

* Ambetter Health of Pennsylvania, Inc.: Approved rate 37.8% (requested 30.1%).

* Capital Advantage Assurance Company: Approved rate 24.6% (requested 26.0%).

* Geisinger Health Plan: Approved rate 11.6% (requested 14.1%).

* Geisinger Quality Options: Approved rate 13.8% (requested 16.2%).

* Health Partners Plans, Inc.: Approved rate 16.7% (requested 7.3%).

* Highmark, Inc.: Approved rate 17.7% (requested 17.2%).

* Highmark Benefits Group: Approved rate 18.4% (requested 17.9%).

* Highmark Coverage Advantage: Approved rate 14.5% (requested 14.1%).

* Keystone Health Plan Central: Approved rate 22.4% (requested 27.9%).

* Keystone Health Plan East: Approved rate 22.0% (requested 23.5%).

* Oscar Health Plan of PA: Approved rate 23.1% (requested 21.6%).

* Partners Insurance Company, Inc.: Approved rate -10.1% (requested -10.1%).

* QCC Insurance Company: Approved rate 15.2% (requested 16.7%).

* UPMC Health Options, Inc.: Approved rate 20.2% (requested 11.7%).

* UPMC Health Plan, Inc.: Approved rate 24.8% (requested 16.3%).

Some insurers cited worsening morbidity, medical/drug trends, and changes at the federal level as reasons for the higher rates than initially requested, according to state officials.

In a statement, the state insurance department noted that individual circumstances, including age, location, income, family size, and market competition, impact what an individual pays and the level of subsidy they may receive.

"Now, more than ever, we encourage consumers to shop when Open Enrollment begins this November," Humphreys said.

Pennie's Open Enrollment period, which is the only time to enroll in individual and family coverage for 2026 without a qualifying life change, runs from Nov. 1 to Dec. 15 for coverage starting Jan. 1, 2026. The marketplace offers free assistance by phone and in-person across the state. For more information, visit pennie.com or call 1-844-844-8040 for assistance.

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

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