(The Center Square) – For months, the looming threat of higher insurance premiums has hung over the commonwealth, while at the federal level, affordable health care access has been at the heart of the debate causing the government shutdown.
Congress is rapidly running out of time to come to an agreement extending Affordable Care Act tax credits before the Nov. 1 open enrollment period begins.
Tuesday, the Pennsylvania Insurance Department formally announced the 2026 rates for those who purchase insurance through the ACA from the state’s marketplace, Pennie, if nothing changes over the next two weeks.
The increases are significant as predicted, and many providers expect the cost burden to push insurance out of reach for low- and middle-income families.
“These increases are higher than in recent years, even after PID’s strong rate review process blocked a number of excessive increases that insurers requested,” said Pennsylvania Insurance Commissioner Michael Humphreys. “Soon, Pennsylvanians who purchase their own coverage will be receiving renewal letters from their insurers and from Pennie that will contain prices that will be shocking.
The average increase across the marketplace is 21.5% according to PID. During the review process, the agency said it rejected more than $50 million in unjustified increases. In some cases within the individual marketplace, PID settled on higher rates than those requested due to “worsening morbidity,” “federal regulatory changes” and “medical/drug trends.”
The highest increase listed by PID was Ambetter Health of Pennsylvania, Inc. at 37.8%. The lowest was a decrease of 10.1% requested by Partners Insurance Company, Inc.
Pennie has urged users to update their information in preparation for the upcoming changes. In the meantime, the organization along with PID continues to lobby Congress for a solution.
“At Pennie, we’ve heard from Pennsylvanians in every county about how essential high quality, affordable health coverage is both for life-saving care and protection from medical bankruptcy,” said Devon Trolley, Executive Director of Pennie. “We know that the end of the enhanced premium tax credits will put many across Pennsylvania in extremely difficult positions.”
Pennsylvania is not in a unique position. Price hikes are expected nationwide. Analysis of U.S. Census data from KFF, a health policy organization, shows increases across the country, hitting older adults the hardest. They singled out districts in Wyoming, West Virginia, Connecticut, and Illinois for the highest increases.
The organization notes that income and geography play a role in determining increases, supporting concerns that rural regions of the state already squeezed by barriers to access will suffer more than their urban and suburban counterparts. In Pennsylvania, the districts hit hardest are in the central region of the state, represented by Republicans Rep. Scot Perry and Rep. John Joyce.
“Congress still has the ability to act to protect Pennsylvania families, as well families across the country,” said Humphreys. “Now, more than ever, we encourage consumers to shop when Open Enrollment begins this November.”
