The Pennsylvania Insurance Department has approved an average health insurance premium increase of 21.5% for individual private health insurance plans and 12.7% for small business group plans, effective in 2026. These hikes represent some of the most substantial annual rate increases seen in recent years.
Factors Driving the Rate Hikes
The department cited several key factors influencing the rise in premiums:
Escalating healthcare costs and increased utilization of healthcare benefits.
Changes in federal enrollment regulations.
The potential expiration of enhanced premium tax credits at the end of the year, which currently help defray costs for many insured individuals.
During the rate review process, the department rejected $50.1 million in requested premium increases from insurers to moderate overall growth.
Variation Across Plans and Markets
Premium changes vary widely depending on the insurer and market segment:
Ambetter Health of Pennsylvania registered the highest individual plan increase at 37.8%.
Partners Insurance Company is the only individual plan approved for a rate decrease of 10.1%.
On the small group side, Highmark Care Benefits will increase rates by 21.85%.
These plans serve distinct markets—individual plans primarily through the Pennie marketplace, and small group plans covering businesses, which are not offered on Pennie.
Impact of Possible Loss of Premium Tax Credits
If Congress does not renew the enhanced premium tax credits, many subsidized enrollees could face premium costs that more than double, effectively increasing rates by an average of 100% for Pennie enrollees. Department spokesperson Adrian Sipes warns this shift could lead to monthly premiums rising up to fourfold for some consumers.
Should Congress extend the credits now, insurers will reduce rates immediately by 3-5%, lessening the financial burden on consumers. Delays in extension, however, could cause enrollment disruptions as consumers might cancel coverage before new rates reflecting credits are implemented.
Detailed Rate Changes by Insurer
Individual market approved rate changes include:
- Ambetter Health of PA: +37.8%
- Capital Advantage Assurance: +24.6%
- Geisinger Health Plans: +11.6% to +13.8%
- Health Partners Plans: +16.7%
- Highmark Inc. and affiliates: 14.5% to 18.4%
- Keystone Health Plans: ~22%
- Oscar Health Plan: +23.1%
- Partners Insurance: -10.1%
- UPMC Health Plans: +20.2% to +24.8%
Small group market increases range from approximately 6.5% to 21.85%, with the largest hikes seen at Highmark Care Benefits.
What Consumers Can Expect for 2026
Premium costs for private health insurance will not increase uniformly. Variations in age, geographic location, family size, income level, and local competition will affect individual premiums and available subsidies.
Consumers should closely review plan options during the upcoming open enrollment period (Nov 1–Dec 15) and monitor congressional action on premium tax credits to make informed decisions about their coverage.
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