Pennsylvanians face higher health insurance costs as insurers propose 19% increase to 2026 premiums

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Health insurance may become more costly for some Pennsylvanians next year if premium rates rise and boosted federal tax credits go away.

Insurance carriers offering plans on Pennie, the state's Affordable Care Act marketplace, are proposing, on average, a 19% increase to premiums for individuals and a 13% increase to premiums for small businesses and groups in 2026.

The Pennsylvania Insurance Department is set to review the proposals and make final approvals this fall. State officials are urging residents to weigh in and submit public comment by Sept. 2.

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State officials consider personal testimonials and stories on how rate increases could affect their ability to purchase and pay for coverage in evaluating premium proposals to ensure they're "not excessive or inadequate – and are not unfairly discriminatory."

"This year, even more than previous years, Pennsylvanians should consider shopping around to find the best plans to meet their individual needs, at a price that makes sense for their current financial situation," said Pennsylvania Insurance Commissioner Michael Humphreys in a statement.

A record 496,661 people enrolled in health insurance plans through Pennie during last year's open enrollment period, according to state data.

About 90% of enrollees were eligible for premium tax credits, which are calculated based on a person's income and reduce the amount someone must pay for monthly premiums.

Since 2021, additional tax credits, known as enhanced premium tax credits, have helped Pennsylvanians save even more money. But those credits are set to expire at the end of this year if Congress does not extend them with funding.

Experts say that could make it more difficult for some Pennsylvanians to afford insurance next year.

Health insurance companies in Pennsylvania say they're requesting higher premium rates to better cover the rising costs of health care broadly and a higher use of benefits for more expensive outpatient services and medications.

Companies also said the anticipated end of enhanced premium tax credits will likely cause some healthy people to drop coverage entirely, which means the pool of people who remain insured will be, on average, sicker than before and more likely to use their insurance for costly health care.

Proposed premium hikes in Pennsylvania vary widely based on insurance carrier, specific plan and where someone lives.

For example, in the individual market, Ambetter Health of Pennsylvania is requesting an average premium rate increase of 30.1%; Capital Advantage Assurance Company is requesting an increase of 26%; and Keystone Health Plan East is requesting an increase of 23.5%.

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There's only one outlier on the list: Partners Insurance Company, which offers individual plans in Southeastern Pennsylvania and the Lehigh Valley, is requesting an average rate decrease of 10.1%.

Despite the requested premium increases, Humphreys said the state has a competitive ACA insurance market and residents should still have their pick of different options at various price points when open enrollment begins Nov. 1.

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