Pennsylvania health insurers are asking for an average 19% increase for individual ACA plans
It’s the biggest requested increase in at least 10 years. The Pennsylvania Insurance Department's review of the requests typically lead to changes.
Pennsylvania health insurers are asking for an average 19% increase for individual Affordable Care Act plans that will take effect next year, the state insurance department said Friday.
It’s the biggest requested increase in at least 10 years for plans sold on Pennsylvania’s Obamacare marketplace.
The insurance department attributed the sharp increase to rising medical costs, increased use of benefits by individuals, and the expected loss this year of enhanced tax credits, which ensure that no one spends more than 8.5% of their income on premiums.
Pennie, the state’s ACA insurance exchange, had record enrollment of 500,000 people this year, but officials there predicted that 150,000 would no longer be able to afford coverage if the enhanced tax credits end.
The requested rate increases announced Friday are not final. The insurance department will review them and release approved rates in the fall. Consumers can comment on the proposed rates by sending an email to ra-in-comment@pa.gov through Sept. 2.
The requested average rate increases for small businesses with two to 50 employees was 13%, the department said.
KFF, a national health policy nonprofit, reported last month that 105 ACA Marketplace insurers in 19 states and Washington, D.C., requested a median premium increase of 15% for 2026.
If approved, KFF said, that would be the biggest increase since 2018, when the first Trump administration and Congress failed to provide money for cost-sharing subsidies that were built in the ACA.
Local plans
Independence Blue Cross and its subsidiary Keystone Health Plan East are the biggest plans in Southeastern Pennsylvania. IBX requested a 16.7% increase. Keystone asked for 23.5%.
The two plans have statewide Pennie market share of 26%, despite selling plans only in Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties.
Jefferson Health Plans, owned by Thomas Jefferson University, is expanding next year to cover three more counties in areas served by Lehigh Valley Health Network, which Jefferson acquired a year ago. The new counties are Schuylkill, Carbon, and Monroe.
This year, Jefferson sold plans in Bucks, Delaware, Lehigh, Montgomery, Northampton, and Philadelphia Counties. It had 3% of the statewide market. The company requested a 7.3% rate increase.