2026 Gross Rate Changes - Pennsylvania: +19.8%; 560,000 enrollees looking at massive rate hikes in January (updated)

Originally posted 8/04/25

via the Pennsylvania Insurance Dept:

Pennsylvanians can submit comments on rate requests and filings through September 2

Harrisburg, PA – The Pennsylvania Insurance Department (PID) today announced that the 2026 rate changes requested by insurance companies currently operating in Pennsylvania’s individual and small group markets are now available. On average, all Pennsylvania health insurers are requesting premium increases in plan year 2026: 19% increase to premiums in the individual market (for people who buy their own insurance), and a 13% increase to premiums in the small group market (for small businesses). 

“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. “Pennsylvania is fortunate to have a competitive health insurance marketplace with many plan options to choose from, and Pennie 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.” 

The requested rate increases for Plan Year 2026 as filed by insurers are results of: 

• The rising cost of health care;   
• The higher use of benefits, including for more expensive outpatient services and medication; and   
• The end of the Enhanced Premium Tax Credits (Tax Credits), which are set to expire on December 31, 2025, unless Congress acts to extend them. 

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with PID for review and approval before plans can be sold to consumers, serving as an important consumer protection. The proposed rates reflect the expected claims and operational costs for the upcoming year. PID reviews rates to ensure that the rates are not excessive or inadequate – and are not unfairly discriminatory. The premiums consumers are charged will be based on the rates that are approved after review.   

Public comment on rate requests and filings will be accepted through September 2, 2025, and can be emailed to ra-in-comment@pa.gov. 

Rate filings for 2026 health insurance plans were submitted to PID on May 15, 2025. Proposed rate changes vary by plan and region and are subject to change as the department conducts its review process. Final approved rates will be made public in the fall.  

Insurers who are currently selling in the individual market that propose selling plans in 2026 have filed plans requesting an average statewide increase of 19%. The rates are rounded to the nearest tenth and vary by region:  

• Ambetter Health of Pennsylvania Inc: Average rate increase request 30.1% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9); 
• Capital Advantage Assurance Company: Average rate increase request 26%; (rating areas 6,7 and 9); 
• Geisinger Health Plan: Average rate increase request 14.1% (rating areas 2,3,5,6,7 and 9); 
• Geisinger Quality Options: Average rate increase request 16.2% (rating areas 2,3,5,6,7 and 9); 
• Health Partners Plans “Jefferson Health Plans": Average rate increase request 7.3% (rating areas 3, 6 and 8); 
• Highmark Benefits Group Inc.: Average rate increase request 18% (rating areas 3 and 8);  
• Highmark Coverage Advantage Inc.: Average rate increase request 14.1% (rating areas 1 and 4);  
• Highmark Inc.: Average rate increase request 17.2% (rating areas 1,2,4,5,6,7 and 9);  
• Independence Blue Cross (QCC Ins. Co.): Average rate increase request 16.7% (rating area 8);  
• Keystone Health Plan Central: Average rate increase request 27.9% (rating areas 6,7 and 9);  
• Keystone Health Plan East Inc.: Average rate increase request 23.5% (rating area 8);  
• Oscar Health Plan of PA: Average rate increase request 22% (rating Areas 3, 6, 7 and 8);  
• Partners Insurance Company Inc.: Average rate increase request -10.1% (rating area 3, 6, and 8);  
• UPMC Health Options Inc.: Average rate increase request 11.7% (rating areas 1,2,3,4,5,6,7 and 9); and  
• UPMC Health Plan Inc.: Average rate increase request 16.3% (rating areas 1 and 5).  

 Ambetter is a new plan for Centene in the individual market, transitioning from the previous plan, Pennsylvania Health & Wellness. UPMC Health Plan is a new plan for UPMC in the individual market, transitioning from the previous plan, UPMC Health Coverage. 

Insurers in Pennsylvania's small group market have filed 2026 plans requesting an average statewide increase of 13%.   

• Capital Advantage Assurance Company: Average rate increase request 14.8% (rating areas 6 ,7, and 9); 
• Geisinger Health Plan: Average rate increase request 11.4% (rating areas 2, 3, 5, 6, 7, and 9);  
• Geisinger Quality Options: Average rate increase request 12.5% (rating areas 2, 3, 5, 6, 7, and 9);  
• Highmark Inc.: Average rate increase request 15.7% (rating areas 1, 2, 4, 5, 6, 7, and 9);  
• Highmark Benefits Group: Average rate increase request 16.6% (rating areas 6, 7, and 9);  
• Highmark Care Benefits: Average rate increase request 22.5% (rating area 3);  
• Highmark Coverage Advantage: Average rate increase request 17% (rating areas 1, 2, 4, 5, and 6);  
• Highmark Senior Health Company: Average rate increase request 12.3% (rating area 8);  
• Independent Assurance Company: Average rate increase request 11% (rating area 8);  
• Keystone Health Plan Central: Average rate increase request 17.6% (rating areas 6, 7, and 9);  
• Keystone Health Plan East/AmeriHealth HMO Inc.: Average rate increase request 16.7% (rating area 8);  
• UnitedHealthcare Insurance Company: Average rate request 10.7% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);  
• UnitedHealthcare of PA: Average rate increase request 20% (rating areas 1, 2, 3, 4, 5, 6, 7, 8, and 9);  
• UPMC Health Benefits: Average rate increase request 6.5% (rating areas 1 and 5);  
• UPMC Health Options Inc.: Average rate increase request 8.9% (rating areas 1, 2, 4, and 5); and  
• UPMC Health Plan Inc.: Average rate increase request 8.2% (rating areas 1, 2, 4, and 5).  

UPMC Health Plan is a new plan for UPMC in the small group market, transitioning from the previous plan, UPMC Health Coverage. Highmark Care Benefits is a new plan for Highmark in the small group market, transitioning from the previous plan, First Priority Life Insurance Company. 

For carriers which don't publicly clarify how much the IRA subsidies expiring are impacting unsubsidized rate changes I'm substituting the CBO's projection of 4.3% for 2026 from last December.

It's important to remember that these are just for unsubsidized, full price premiums. The impact on net rate hikes for the vast majority of ACA exchange enrollees will be much higher than 19.2%.

NOTE: This press release and the accompanying filings were posted by the official Pennsylvania Insurance Dept. on August 1st. However, the federal rate review database has some different requested rate changes (for instance, they have Ambetter (30.08%) down as requesting a 39.51% avg. rate hike)...and even then, some of the actual actuarial filings themselves list a third requested rate (Ambetter Health of PA's says it's 38.7%).

UPDATE 8/14/25: I've decided to go ahead and update the rate changes for the carriers which differ from the PA PID website with revised rates on the filings themselves.

This results in a slight increase in the overall weighted average to 19.8%.