Changes proposed for Pennsylvania health insurance prices

(WHTM) – Some Pennsylvanians could soon be paying more for their health insurance.

The Pennsylvania Insurance Department announced Tuesday that rate changes have been requested by insurance companies operating in the state’s individual and small group markets.

On average, all Pennsylvania health insurers are requesting premium increases in plan year 2026. The proposed changes would mean a 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). 

The requested rate changes are due to rising costs in health care, higher use of benefits, and the scheduled end of the Enhanced Premium Tax Credits, barring an extension by Congress before December 31, 2025.

“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,” Humphreys added. “So, despite the increase in cost, PID is confident consumers will have numerous affordable insurance plans to choose from during Open Enrollment.”

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. 

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

Last year, the Insurance Department reported that most proposed rate increases for 2025 were about 8%.