Pennie rates rise for 2027; inflation, Congressional changes among factors

HARRISBURG — Health insurance rates through Pennie, Pennsylvania's Affordable Care Act marketplace, are on the rise again.

The Pennsylvania Insurance Department announced that rates will grow by an average of 15.97% for individual customers and 10.28% for small businesses with 50 or fewer employees.

The average increase is lower than what insurers collectively sought — 17.14% for individuals and 11.49% for the small-group market.

The department prevented nearly an additional $95 million from being charged to consumers by blocking certain aspects of the requested rate changes, Insurance Commissioner Michael Humphreys said, but it only serves to blunt yet another cost increase.

In 2026, the average increase for individuals shopping through Pennie was 21.5% while small groups paid 12.7% more. The average increases in 2025 were 6% for individuals and 7.6% for small groups.

"Unfortunately, health care cuts by the federal government continue to drive up costs for Pennsylvania families," Humphreys said. "We understand that these rate increases are rough on Pennsylvania families and businesses, and we fought insurers for every savings we could reasonably assert."

The department pointed to usage of prescription medication and medical care as well as rising costs in general for the increase. It also blamed Congress for failing to reauthorize enhanced premium tax credits for 2026 and beyond, which it says continues to cause people to drop coverage. That results in those who are uninsured seeking care regardless; however, without coverage, it becomes far more costly and impacts hospital finances and insurance rates. The department also cites the Medicaid work requirements set into law within the One Big Beautiful Bill adopted in 2025.

"PID's rate review process requires insurers to justify every dollar they propose to charge with data to support the rate," Humphreys said. "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 $95 million for Pennsylvanians, while facing realities that saw Pennsylvania's individual and small group market insurers pay $845 million more in 2025 medical and prescription drug claims than they paid in 2024 — a 13 percent increase in claims costs."

While PID works to lower the requested rate increases, three insurers saw rates grow beyond what was sought.

Health Partners Plans Inc. requested an increase of 15.9%. PID raised the request to 18.3% to cover "less health membership," which the department said was confirmed through the federal risk adjustment program.

Keystone Health Plan East requested a 14.7% increase but was granted an increase of 16%; QCC Insurance Co. sought 19.9% and was granted 21.3%. PID cited worsening medical and drug trends as the reasoning for each.

The average increases calculated for 2027 won't be close to what's actually paid by some consumers.

PID says the rate increases vary significantly for consumers based on the coverage they purchase, the region where they live, market competition, and their individual circumstances like income and the size of their family. Some consumers could see a decrease while others will see substantially greater increases.

Pennie highlights what its plans offer — coverage for pre-existing conditions, preventative care, hospital visits and prescription coverage and protection against soaring costs due to a health emergency. It also offers financial assistance to lower monthly premiums and out-of-pocket costs.

Open enrollment runs from Nov. 1 through Dec. 15. Beyond that, enrollment is limited to those who experience significant life changes like lost coverage through Medicaid. For more information, visit www.pennie.com or call 1-844-844-8040.

The following is a look at the requested and approved rate increases for insurers in the individual marketplace. Additional information, including on insurers in the small group market, can be found under the Affordable Care Act Health Rate Filing section of www.pa.gov/agencies/insurance:

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

Capital Advantage Assurance Company: Requested, 18.3%; approved, 14.8%;

Geisinger Health Plan: Requested, 10.5%; approved, 8.6%;

Geisinger Quality Options: Requested, 13.0%; approved, 10.7%;

Health Partners Plans Inc: Requested, 15.9%; approved, 18.3%;

Highmark Benefits Group: Requested, 21.4%; approved, 19.7%;

Highmark Inc: Requested, 16.2%; approved, 14.5%

Keystone Health Plan Central: Requested, 33.8%; approved, 33.4%;

Keystone Health Plan East: Requested, 14.7%; approved, 16%;

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

Partners Insurance Company Inc: Requested, 20.5%; approved, 18.8%;

QCC Insurance Company: Requested, 19.9%; approved, 21.3%;

UPMC Health Network Inc: Requested, 12%; approved, 9.7%;

UPMC Health Plan Inc: Requested, 15.8%; approved, 13.5%.

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