Pennsylvania

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Two things are true as of today: 2026 ACA Open Enrollment has ended...and 2026 ACA Open Enrollment is still going on (in some states).

The official Open Enrollment Period ended yesterday at midnight across 41 states...but residents of the other 9 (plus DC) still have time to enroll for coverage starting February 1st.

A few minutes ago I posted a press release from Pennie (Pennsylvania's state-based ACA exchange). The release mostly focuses on the upcoming final Open Enrollment Period deadline for February coverage in the Keystone State (January 31st), but it also includes a couple of depressing (if completely predictable) stats at the end:

Costs have risen by 102% for Pennie enrollees in 2026 due to the expiration of the enhanced premium tax credits. Congress has not extended these critical savings. To date, over 70,000 Pennsylvanians have dropped coverage as a result of the higher prices – nearly 1,000 a day for most of Open Enrollment. More information can be found at pennie.com/affordability.

I did indeed visit that link, where I found the following additional details (the data provided is as of January 20th...unfortunately they don't actually list the total 2026 plan selections anywhere for some reason):

via Pennie:

A Officials urge all Pennsylvanians without health coverage to visit pennie.com to get protected during the Open Enrollment Period.   

PENNSYLVANIA – January 22, 2026 – Time is running out to enroll in health coverage through Pennie for 2026. The Open Enrollment Period will close on January 31st, marking the final opportunity for Pennsylvanians to sign up for health insurance for the year ahead. Due to federal changes causing higher health plan costs, Pennie extended the Open Enrollment deadline to January 31st ensuring Pennsylvanians have additional time to review their options and secure coverage.  

Pennie, the Commonwealth’s official health insurance marketplace, is currently open at pennie.com and offers high-quality coverage options for individuals and families who do not have access to other health insurance. If you or someone you know does not currently have health coverage, this is the final time to act and visit pennie.com to explore your options to get enrolled.   

We're now over the hump: The initial deadline for people to enroll in ACA healthcare coverage starting on January 1st has passed in most states.

HOWEVER, there's some important caveats to this, as well as some last-minute deadline extensions in a couple of states, so let's dig in...

  • If you live in IDAHO, last night was the one and only Open Enrollment Period deadline.

This means that if you didn't actively select a plan for 2026, current enrollees are stuck with whatever plan Your Health Idaho automatically renewed theme into, while uninsured residents who didn't sign up by the deadline are mostly out of luck.

The exceptions to this for both categories are a) if they're members of a federally-recognized Native American tribe (or are Alaska Natives); or b) if they are (or become) eligible for Medicaid or the Children's Health Insurance Program (CHIP). All of these are eligible to enroll year-round.

IMPORTANT: Premium Alignment is NOT a substitute for making the enhanced ACA tax credits permanent. It does little to help the lowest-income folks who are still better off with Silver plans thanks to robust CSR assistance, and the benefits of it will be mediocre for those over 400% FPL if the enhanced tax credits expire.

Even for those it benefits the most (primarily those who earn between 200 - 400% FPL),  it's a complement to the upgraded subsidies, not a replacement for them.

HOWEVER, it's still hugely helpful to those who know how to take advantage of it, and particularly in the states newly implementing it, it should relieve a huge portion of the pain being caused by the enhanced APTC expiring next month.

I've written multiple times in the past about "Silver Loading," the ACA health insurance policy pricing strategy in which insurance carriers load the extra cost of their Cost Sharing Reduction financial burden (the portion of deductibles, co-pays & coinsurance which they're required to cover themselves for low-income enrollees who select Silver plans) onto the gross premium of those same Silver plans.

It gets a bit wonky, but the bottom line is that Silver Loading results in the gross price of Silver ACA plans increasing significantly even if the price of Bronze, Gold & Platinum plans only go up modestly. This may sound bad, but stay with me.

From the carriers perspective, how the CSR load is allocated doesn't matter much as long as they aren't left stuck with the bill...but pricing the plans in this fashion has major implications for the enrollees themselves.

Originally posted 8/04/25

10/15/25: Scroll down for FINAL rate filings

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). 

Originally posted 1/29/25

Pennsylvania has around ~496,000 residents enrolled in ACA exchange plans, 87% of whom are currently subsidized. I estimate they also have another ~103,000 unsubsidized off-exchange enrollees.

Combined, that's 600,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 560,000 statewide.

via Pennie:

PENNSYLVANIA – August 26, 2025 – Pennie, Pennsylvania’s official health insurance marketplace, in coordination with Health Market Connect LLC (HMC), the newly appointed contractor of Pennie’s Assister Network, is taking a major step forward in connecting the uninsured with affordable health coverage. Pennie and HMC are launching a new network of regional organizations dedicated to providing localized support throughout the Commonwealth.

This innovative and community-centered model is designed to ensure that every Pennsylvanian, regardless of where they live, has access to trusted, in-person assistance when exploring their health coverage options. The appointed regional organizations will be responsible for hiring local Pennie-Certified Assisters who will serve as trusted guides throughout the enrollment process and conducting outreach to the uninsured.

Originally posted 3/14/25

Over the past couple of months I've compiled a master spreadsheet breaking out enrollment in ACA plans (Qualified Health Plans & Basic Health Plans), Medicaid/CHIP coverage (both traditional & via ACA expansion) and Medicare (both Fee-for-Services & Advantage) at the Congressional District levels.

With the pending dire threat to several of these programs (primarily Medicaid & the ACA) from the House Republican Budget Proposal which recently passed, I'm going a step further and am generating pie charts which visualize just how much of every Congressional District's total population is at risk of losing healthcare coverage.

USE THE DROP-DOWN MENU ABOVE TO FIND YOUR STATE & DISTRICT.

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