Pennsylvania health insurers request a 19% average increase for individual Affordable Care Act plans.
Pennsylvania health insurers have submitted an average request for a 19% increase for individual Affordable Care Act (ACA) plans, marking the most significant proposed escalation in a decade. This information was shared by the state insurance department on Friday, drawing attention to the ongoing challenges within the healthcare market.
The primary contributors to this substantial rate hike have been attributed to escalating medical costs, increased utilization of benefits by policyholders, and the anticipated loss of enhanced tax credits. These tax credits currently protect consumers from spending more than 8.5% of their income on premiums, making their potential discontinuation a critical factor in the rate requests.
The state’s ACA insurance exchange, known as Pennie, experienced record enrollment this year, with approximately 500,000 individuals signing up for coverage. However, officials from Pennie have expressed concerns that if the enhanced tax credits are removed, around 150,000 individuals could become unable to afford their premiums and consequently lose their coverage.
It is important to note that the proposed rates announced by the insurers are not yet finalized. The Pennsylvania insurance department will conduct a thorough review of these requests and will announce the approved rates later in the fall. Consumers are encouraged to voice their opinions regarding the proposed increases, with the opportunity to submit comments via email to the department until September 2.
For small businesses employing between two to 50 individuals, the average requested rate increase stands at 13%. This development is in line with a broader trend observed nationally, where a report from the Kaiser Family Foundation indicated that 105 ACA Marketplace insurers across 19 states and Washington D.C. have sought a median premium increase of 15% for 2026. If sanctioned, this rate adjustment would be the steepest since 2018, a year marked by significant changes to federal funding for ACA-related subsidies.
Among the prominent players in the Southeastern Pennsylvania market, Independence Blue Cross and its subsidiary Keystone Health Plan East have proposed a rate increase of 16.7% and 23.5%, respectively. Together, they command a statewide market share of 26% within the Pennie exchange, despite only offering plans in select counties.
Additionally, Jefferson Health Plans, part of Thomas Jefferson University, is poised to expand its service area next year into three new counties—Schuylkill, Carbon, and Monroe—following its acquisition of the Lehigh Valley Health Network. This year, Jefferson Health Plans held a 3% market share and proposed a modest increase of 7.3% to its rates.
As the landscape of health insurance pricing evolves in Pennsylvania, the forthcoming decisions from the insurance department will play a crucial role in determining accessibility and affordability for residents. Media News Source continues to monitor these developments as they unfold.
