Pennie customers likely to see increase in ACA costs

The Daily Item

According to the state department data released Tuesday, new federal rules and expiring subsidies mean Pennsylvanians who buy their own coverage will see an average aggregate weighted rate increase of 21.5% in the individual market.

Enhanced Premium Tax Credits introduced under the Biden administration expanded both savings and eligibility of existing tax credits authorized within the ACA. From 2020 to 2025, subsidies and eligibility changes doubled ACA Marketplace enrollment from 11.4 million people in 2020 to 24.3 million in 2025, according to the Peterson-KFF Health System Tracker.

The enhanced credits will expire Dec. 31 without an extension authorized by Congress, one of the key components of the ongoing federal government shutdown. Additionally, according to KFF, the Trump administration made changes to the way tax credits are calculated, which were finalized in the ACA Marketplace Integrity and Affordability rule.

“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. 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,” Pennsylvania Insurance Commissioner Michael Humphreys said. “Congress still has the ability to act to protect Pennsylvania families, as well as families across the country. Now, more than ever, we encourage consumers to shop when Open Enrollment begins.”

Open enrollment begins Nov. 1.

During the rate review process, PID officials worked directly with insurers to correct their projections when the data didn’t match current conditions. PID reduced the small group average increase to 12.7%, down from initial requests that averaged 13.1%. The PID notes spikes in premium rates are being seen across the country.

Approved average rate changes in the individual market are below. Please visit the Insurance Department website within www.pa.gov and search under “Product and Rate Filing Requirements” to find the corresponding map for rating areas:

Ambetter Health of Pennsylvania Inc.: approved, 37.8% due to worsening morbidity; requested, 30.1% (rating areas 1, 2, 3, 4, 5, 6, 7, 8 and 9);

Capital Advantage Assurance Co.: approved, 24.6%; requested, 26% (rating areas 6,7 and 9);

Geisinger Health Plan: approved, 11.6%; requested, 14.1% (rating areas 2,3,5,6,7 and 9);

Geisinger Quality Options: approved, 13.8%; requested, 16.2% (rating areas 2,3,5,6,7 and 9);

Health Partners Plans “Jefferson Health Plans”: approved, 16.7% due to worsening morbidity and medical/drug trends; requested, 7.3% (rating areas 3, 6 and 8);

Highmark Inc.: approved, 17.7%; requested, 17.2% (rating areas 1, 2, 4, 5, 6, 7, 9)

Highmark Benefits Group Inc.: approved, 18.4%; requested, 17.9% (rating areas 3 and 8);

Highmark Coverage Advantage Inc.: approved, 14.5%; requested, 14.1% (rating areas 1 and 4);

Independence Blue Cross (QCC Ins. Co.): approved, 15.2%; requested, 16.7% (rating area 8);

Keystone Health Plan Central: approved, 22.4%; requested, 27.9% (rating areas 6,7 and 9);

Keystone Health Plan East Inc.: approved, 22%; requested, 23.5% (rating area 8);

Oscar Health Plan of PA: approved, 23.1%; requested, 21.6% (rating Areas 3, 6, 7 and 8);

Partners Insurance Company Inc.: requested and approved, -10.1% (rating area 3, 6, and 8);

UPMC Health Options Inc.: approved, 20.2% due to worsening morbidity and federal regulatory changes; requested 11.7% (rating areas 1,2,3,4,5,6,7 and 9); and

UPMC Health Plan Inc.: approved, 24.8% due to worsening morbidity and federal regulatory changes; requested 16.3% (rating areas 1 and 5).

Average rate changes approved in the small group market are as follows:

Capital Advantage Assurance Co.: approved, 14.7%; requested, 14.8% (rating areas 6 ,7, and 9);

Geisinger Health Plan: approved, 11.3%; requested, 11.4% (rating areas 2, 3, 5, 6, 7, and 9);

Geisinger Quality Options: approved, 12.4%; requested, 12.5% (rating areas 2, 3, 5, 6, 7, and 9);

Highmark Inc.: approved, 14.6%; requested, 15.7% (rating areas 1, 2, 4, 5, 6, 7, and 9);

Highmark Benefits Group: approved, 15.6%; requested, 16.6% (rating areas 6, 7, and 9);

Highmark Care Benefits: approved, 21.8%; requested, 22.5% (rating area 3);

Highmark Coverage Advantage: approved, 15.9%; requested, 16.9% (rating areas 1, 2, 4, 5, and 6);

Highmark Senior Health Company: requested and approved, 12.3% (rating area 8);

Independent Assurance Company: approved, 10.7%; requested, 11% (rating area 8);

Keystone Health Plan Central: approved, 17.5%; requested, 17.6% (rating areas 6, 7, and 9);

Keystone Health Plan East/AmeriHealth HMO Inc.: approved, 16.4%; requested, 16.7% (rating area 8);

UnitedHealthcare Insurance Co.: approved, 7.9%; requested, 10.7% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);

UnitedHealthcare of PA: approved, 12.6%; requested, 20% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);

UPMC Health Benefits: approved and requested, 6.5% (rating areas 1 and 5);

UPMC Health Options Inc.: approved and requested, 8.9% (rating areas 1, 2, 4, and 5);

UPMC Health Plan Inc.: approved and requested, 8.2% (rating areas 1, 2, 4, and 5).

“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 will put many across Pennsylvania in extremely difficult positions,” Devon Trolley, executive director of Pennie, said. “Throughout these changes, Pennie will be here to provide up-to-date information and support about plan costs and options for 2026. All current Pennie enrollees should update their information and review their 2026 plan options during Pennie’s Open Enrollment Period, starting this November.”

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