Finalized health insurance rates for 2026 show an average increase of 21.5% for individual plans and 12.7% for small business group plans in Pennsylvania.
The Pennsylvania Insurance Department, which approved the new rates, attributed the increases in part to rising health care costs, higher use of benefits, changes in federal enrollment rules and the potential loss of enhanced premium tax credits, which will expire at the end of the year without action by Congress.
The exact increases vary across plans, and some are lower or higher than what insurance companies originally proposed. The department said it denied $50.1 million in insurance premium increases during its review process.
The individual market plans are for people who purchase coverage on their own, and most are available through Pennie, the state’s official health insurance marketplace. The small group market plans, which are for small businesses, are not available through Pennie.
Ambetter Health of Pennsylvania, Inc. listed the largest increase in the individual market, at 37.8%. Partners Insurance Company, Inc. was approved for a decrease of 10.1%, making it the only plan in the individual market to lower its rates.
The largest increase among small group market plans was Highmark Care Benefits, which will raise rates by 21.85%.
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Health insurance rates in 2026 will not look the same for everyone who uses the Pennie marketplace — while some people may see a cost increase, others may see a decrease, the department said. Age, location, household income, family size and market competition all have an impact on what someone pays and what subsidy they might receive.
The approved rate increases reflect costs before the enhanced premium tax credits, department spokesperson Adrian Sipes said by email. If the tax credits end, people who were once eligible will have to contend with the loss of these subsidies on top of expected premium increases, according to health information nonprofit KFF, which could more than double what subsidized enrollees pay.
Losing the enhanced premium tax credits “could exponentially increase rates for Pennie plans by an average of 100% for all enrollees, with many enrollees paying up to four times as much each month,” Sipes said.
If the enhanced premium tax credits are extended now, the department would work with insurers to immediately reduce rates by three to five percent, Sipes said. And this would prevent the much higher cost increases residents would face if the tax credits went away.
If Congress extends the tax credits after the start of open enrollment, which runs from Nov. 1 to Dec. 15, the department will “work with Pennie and insurers to implement the changes necessary to reflect the credits,” he said. But Sipes warned that by then, thousands of consumers may have already opted out of coverage due to cost, and it may be difficult to convince them to review the updated rates.
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Individual market plans
• Ambetter Health of Pennsylvania Inc.: requested rate increase of 30.1%; approved rate 37.8%, due to increased disease.
• Capital Advantage Assurance Company: requested rate increase of 26.0%; approved rate 24.6%.
• Geisinger Health Plan: requested rate increase of 14.1%; approved rate 11.6%.
• Geisinger Quality Options: requested rate increase of 16.2%; approved rate 13.8%.
• Health Partners Plans Inc.: requested rate increase of 7.3%; approved rate 16.7%, due to increased disease and medical/drug trends.
• Highmark Inc.: requested rate increase of 17.2%; approved rate 17.7%.
• Highmark Benefits Group: requested rate increase of 17.9%; approved rate 18.4%.
• Highmark Coverage Advantage: requested rate increase of 14.1%; approved rate 14.5%.
• Keystone Health Plan Central: requested rate increase of 27.9%; approved rate 22.4%.
• Keystone Health Plan East: requested rate increase of 23.5%; approved rate 22.0%.
• Oscar Health Plan of PA: requested rate increase of 21.6%; approved rate 23.1%.
• Partners Insurance Company Inc.: requested rate decrease of 10.1%; approved rate decrease of 10.1%.
• QCC Insurance Company: requested rate increase of 16.7%; approved rate 15.2%.
• UPMC Health Options Inc.: requested rate increase of 11.7%; approved rate 20.2%, due to increased disease and federal regulatory changes.
• UPMC Health Plan Inc.: requested rate increase of 16.3%; approved rate 24.8%, due to increased disease and federal regulatory changes.
Source: Pennsylvania Insurance Department
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Small group market plans
•Capital Advantage Assurance Company: requested rate increase of 14.82%; approved rate 14.75%.
• Geisinger Health Plan: requested rate increase of 11.41%; approved rate 11.27%.
• Geisinger Quality Options: requested rate increase of 12.53%; approved rate 12.39%.
• Highmark Inc.: requested rate increase of 15.71%; approved rate 14.64%.
• Highmark Benefits Group: requested rate increase of 16.56%; approved rate 15.64%.
• Highmark Care Benefits: requested rate increase of 22.45%; approved rate 21.85%.
• Highmark Coverage Advantage: requested rate increase of 16.89%; approved rate 15.95%.
• Highmark Senior Health Company: requested rate increase of 12.26%; approved rate 12.26%.
• Independence Assurance Company: requested rate increase of 11.01%; approved rate 10.74%.
• Keystone Health Plan Central: requested rate increase of 17.64%; approved rate 17.58%.
• Keystone Health Plan East/AmeriHealth HMO Inc.: requested rate increase of 16.67%; approved rate 16.37%.
• UnitedHealthcare Insurance Company: requested rate increase of 10.72%; approved rate 7.90%.
• UnitedHealthcare of PA: requested rate increase of 19.97%; approved rate 12.60%.
• UPMC Health Benefits: requested rate increase of 6.54%; approved rate 6.54%.
• UPMC Health Options Inc.: requested rate increase of 8.88%; approved rate 8.88%.
• UPMC Health Plan Inc.: requested rate increase of 8.22%; approved rate 8.22%.
Source: Pennsylvania Insurance Department
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