Pennsylvania Insurers Propose 19% Premium Hike for 2026
Health insurance costs in Pennsylvania are poised to rise significantly next year, as insurers propose an average premium increase of 19% for individuals and 13% for small businesses and groups in 2026. The proposals, made by various insurance carriers participating in Pennie, the state’s Affordable Care Act marketplace, are currently under review by the Pennsylvania Insurance Department, which is expected to make final decisions this fall.
Residents are encouraged to provide public feedback on these proposals by September 2. State officials emphasize the importance of personal testimonials, as they evaluate whether the proposed rates are “not excessive or inadequate – and are not unfairly discriminatory.”
Michael Humphreys, the Pennsylvania Insurance Commissioner, stated, “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.”
Impact of Expiring Tax Credits
During the last open enrollment period, a record 496,661 individuals enrolled in health insurance plans through Pennie, according to state data. Notably, approximately 90% of these enrollees qualified for premium tax credits, which are determined by income and serve to lower monthly premium costs. Since 2021, enhanced premium tax credits have provided additional financial relief, but these credits are set to expire at the end of the year unless Congress intervenes.
The potential loss of these enhanced credits could create affordability challenges for many residents. Health insurance companies attribute their requests for higher premiums to rising healthcare costs and increased utilization of more expensive outpatient services and medications. They also warn that the anticipated expiration of the enhanced premium tax credits might lead to a decline in healthy individuals maintaining insurance coverage, resulting in a riskier pool of insured individuals more likely to require costly medical care.
Proposed Rate Increases by Insurer
The proposed premium increases vary significantly across different insurance carriers and plans. For instance, in the individual market, Ambetter Health of Pennsylvania is seeking an average increase of 30.1%, while Capital Advantage Assurance Company has proposed a 26% increase, and Keystone Health Plan East is looking for a 23.5% increase. Notably, one company, Partners Insurance Company, which offers individual plans in Southeastern Pennsylvania and the Lehigh Valley, is requesting an average rate decrease of 10.1%.
Despite these proposed hikes, Commissioner Humphreys reassured residents that Pennsylvania maintains a competitive market for Affordable Care Act insurance. He indicated that consumers should still have access to a variety of options at different price points when the open enrollment period begins on November 1. The state’s ongoing commitment to providing affordable health insurance remains a priority, even amid the rising costs being proposed by various insurers.
