HARRISBURG — The cost to buy health insurance in Pennsylvania, be it individually or through a small business employer, will grow substantially in 2026 under rate increases proposed by insurance companies.
Insurers selling in the individual market requested an average 19% increase on premiums. Those selling insurance in the small group market — plans offered through employers with 50 or fewer workers — seek an average increase of 13%.
According to the Pennsylvania Insurance Department, the requested rate increases result from the rising cost of health care, increased use of plan benefits including more expensive outpatient services and medication — both of which are separately cited for rising costs of Medicaid, too — and the pending expiration at year’s end of Enhanced Premium Tax Credits, which Congress could act to extend.
Last year, the average increase was 6% for individuals and 7.6% in the small group market.
“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,” Pennsylvania Insurance Commissioner Michael Humphreys said in a statement. Humphreys previously warned in June that without action by Congress to extend the tax credits, “Pennsylvanians will be forced to choose between coverage and basic necessities. That’s not a choice any family should have to make.”
“Pennsylvania is fortunate to have a competitive health insurance marketplace with many plan options to choose from, and Pennie (Pennsylvania’s online marketplace) makes it easy to shop for plans that cover specific providers and medications. So, despite the increase in cost, PID is confident consumers will have numerous affordable insurance plans to choose from during Open Enrollment,” he said in Friday’s statement.
The range of the proposed increases differs, including by region.
On the low end in the individual market is UPMC Health Options Inc. which requested an 11.7% rate increase compared to a high of 30.1% by Ambetter Health of Pennsylvania Inc., which is a new plan for Centene in the individual market, transitioning from the previous plan, Pennsylvania Health & Wellness.
In the small group market, the lowest requested increase is from UPMC Health Benefits at 6.5%; the high is 22.5%, Highmark Care Benefits, which is transitioning from a previous plan, First Priority Life Insurance Company.
Just one insurer requested a decreased rate. Partners Insurance Company Inc., which is in the individual market, looks to drop its rate by -10.1%.
Pennsylvania requires insurers in the individual and small group markets to file proposed rates annually with the Insurance Department for review and approval. That doesn’t apply to plans offered through large employers with more than 50 employees or self-insured employers.
Public comment is considered as part of the review process. Comments are open and filings will be accepted through Sept. 2: email ra-in-comment@pa.gov.
Proposed 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.: 30.1% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);
Capital Advantage Assurance Co.: 26%; (rating areas 6,7 and 9);
Geisinger Health Plan: 14.1% (rating areas 2,3,5,6,7 and 9);
Geisinger Quality Options: 16.2% (rating areas 2,3,5,6,7 and 9);
Health Partners Plans “Jefferson Health Plans”: 7.3% (rating areas 3, 6 and 8);
Highmark Benefits Group Inc.: 18% (rating areas 3 and 8);
Highmark Coverage Advantage Inc.: 14.1% (rating areas 1 and 4);
Highmark Inc.: 17.2% (rating areas 1,2,4,5,6,7 and 9);
Independence Blue Cross (QCC Ins. Co.): 16.7% (rating area 8);
Keystone Health Plan Central: 27.9% (rating areas 6,7 and 9);
Keystone Health Plan East Inc.: 23.5% (rating area 8);
Oscar Health Plan of PA: 22% (rating Areas 3, 6, 7 and 8);
Partners Insurance Company Inc.: -10.1% (rating area 3, 6, and 8);
UPMC Health Options Inc.: 11.7% (rating areas 1,2,3,4,5,6,7 and 9); and
UPMC Health Plan Inc.: 16.3% (rating areas 1 and 5).
Average rate changes proposed in the small group market are as follows:
Capital Advantage Assurance Co.: 14.8% (rating areas 6 ,7, and 9);
Geisinger Health Plan: 11.4% (rating areas 2, 3, 5, 6, 7, and 9);
Geisinger Quality Options: 12.5% (rating areas 2, 3, 5, 6, 7, and 9);
Highmark Inc.: 15.7% (rating areas 1, 2, 4, 5, 6, 7, and 9);
Highmark Benefits Group: 16.6% (rating areas 6, 7, and 9);
Highmark Care Benefits: 22.5% (rating area 3);
Highmark Coverage Advantage: 17% (rating areas 1, 2, 4, 5, and 6);
Highmark Senior Health Company: 12.3% (rating area 8);
Independent Assurance Company: 11% (rating area 8);
Keystone Health Plan Central: 17.6% (rating areas 6, 7, and 9);
Keystone Health Plan East/AmeriHealth HMO Inc.: 16.7% (rating area 8);
UnitedHealthcare Insurance Co.: 10.7% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);
UnitedHealthcare of PA: 20% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);
UPMC Health Benefits: 6.5% (rating areas 1 and 5);
UPMC Health Options Inc.: 8.9% (rating areas 1, 2, 4, and 5);
UPMC Health Plan Inc.: 8.2% (rating areas 1, 2, 4, and 5).