Pennsylvania regulators approved an average 15.97% increase for 2027 individual-market health insurance plans, including coverage purchased through Pennie. Small businesses will see an average approved increase of 10.28% in the small-group market.
The Pennsylvania Insurance Department (PID) finalized the rates on September 18, 2026. The new rates take effect January 1, 2027.
These are serious increases, but the averages are not predictions of what any one person or business will pay. Your actual premium may change by a very different amount depending on your plan, carrier, region, age, location, household income, family size, and market competition.
The approved increases are lower than insurers requested
For the individual market, insurers initially requested an average increase of 17.14%. PID approved an average aggregate weighted increase of 15.97% after reviewing the filings and denying $94.7 million in unjustified premium increases.
For small-group coverage, insurers initially requested increases averaging 11.49%. PID approved an average increase of 10.28%.
Pennsylvania Insurance Commissioner Michael Humphreys said, “We understand that these rate increases are rough on Pennsylvania families and businesses, and we fought insurers for every savings we could reasonably assert.”
The approved rates apply to the market overall. They do not mean that every Pennie plan will increase by 15.97%. One consumer may see a decrease, while another may see a substantial increase, even when both shop through the same marketplace.
Approved 2027 individual-market increases by carrier
The table below shows the approved individual-market rate change compared with each carrier’s original request:
| Carrier | Requested increase | Approved increase |
|---|---|---|
| Ambetter Health of Pennsylvania Inc. | 40.9% | 35.1% |
| Capital Advantage Assurance Company | 18.3% | 14.8% |
| Geisinger Health Plan | 10.5% | 8.6% |
| Geisinger Quality Options | 13.0% | 10.7% |
| Health Partners Plans Inc. | 15.9% | 18.3% |
| Highmark Benefits Group | 21.4% | 19.7% |
| Highmark Inc. | 16.2% | 14.5% |
| Keystone Health Plan Central | 33.8% | 33.4% |
| Keystone Health Plan East | 14.7% | 16.0% |
| Oscar Health Plan of PA | 15.4% | 1.4% |
| Partners Insurance Company Inc. | 20.5% | 18.8% |
| QCC Insurance Company | 19.9% | 21.3% |
| UPMC Health Network Inc. | 12.0% | 9.7% |
| UPMC Health Plan Inc. | 15.8% | 13.5% |
Three carriers received approved increases higher than their original requests:
- Health Partners Plans Inc.: The approved increase was 18.3%, compared with a 15.9% request. PID attributed the difference to less healthy membership confirmed through the federal risk adjustment program.
- Keystone Health Plan East: The approved increase was 16.0%, compared with a 14.7% request. PID cited worsening medical and prescription drug trends.
- QCC Insurance Company: The approved increase was 21.3%, compared with a 19.9% request. PID also cited worsening medical and prescription drug trends.
These carrier-level differences are why comparing plans during Open Enrollment is especially important.
Why are 2027 rates increasing?
PID identified several factors affecting 2027 premiums.
First, insurers paid $845 million more for medical and prescription drug claims in 2025 than they paid in 2024. That represented a 13% increase in claims costs for insurers in Pennsylvania’s individual and small-group markets.
Higher medical costs and prescription drug spending generally place upward pressure on premiums. Insurers price coverage based on expected claims expenses, including the medical care and prescriptions their members are expected to use.
Second, enhanced federal premium tax credits expired at the end of 2025. After that change, the average Pennie recipient saw a 102% jump in monthly health insurance costs, and approximately 200,000 Pennsylvanians canceled their coverage.
The end of those credits affects what many people pay directly, while the resulting changes in enrollment can also affect the insurance market.
Third, PID cited the July 2025 federal budget law, H.R. 1, which added Medicaid work requirements and new enrollment paperwork. PID expects those changes to leave more Pennsylvanians uninsured in 2027, shifting uncompensated care costs onto providers and premium payers.
This is also the second consecutive year of double-digit individual-market increases. Individual premiums rose an average of 21.5% in 2026.
What the increase means for small businesses
The approved 10.28% average small-group increase is lower than the individual-market average, but it remains meaningful for 2027 budgets.
For a small employer, the effect may reach beyond the monthly premium. A higher group rate can influence the company’s benefits budget, employee contributions, recruiting plans, and decisions about plan design.
The 10.28% figure is an average, not a guaranteed increase for every employer. Actual changes vary by carrier, plan, location, group circumstances, and market competition.
Before renewing, employers should compare the current plan with available alternatives. A plan with a lower premium may have different provider networks, cost-sharing requirements, or prescription drug coverage.
Total Benefit Solutions helps small employers review those tradeoffs and compare available employee-benefit options before making a 2027 decision.
Your 2027 Pennie Open Enrollment action plan
Pennie is Pennsylvania’s official state-based health insurance marketplace and the only place to receive financial assistance that lowers monthly premiums and out-of-pocket costs.
Open Enrollment for 2027 coverage begins November 1, 2026.
To have coverage start on January 1, 2027, you must enroll by December 15, 2026. Pennie’s state-based enrollment window continues through January 15, 2027, for coverage beginning February 1, 2027.
Outside Open Enrollment, only people with qualifying life events can enroll.
Use this checklist:
1. Update your Pennie application
Review your household information, income, family size, address, and other application details. Financial assistance depends on information such as income and household size, so outdated information can affect the results shown to you.
2. Do not automatically renew without reviewing your options
If you simply auto-renew, you accept the new price for your existing plan without comparing it with the other plans available for 2027.
Read your auto-renewal notice when it arrives. Pay attention to the new premium, plan details, and any changes affecting your household.
3. Re-shop your coverage
Plan switching is the single biggest lever when rates move this much. Compare your current plan with other available options rather than assuming that staying put is the best value.
Pennie plans include coverage for pre-existing conditions, essential health benefits such as preventive care, prescriptions, and hospital visits, limits on annual out-of-pocket costs, and protections for emergency care. Plans are available across multiple metal levels (bronze, silver, gold, and platinum) and network types, including HMO, EPO, and PPO.
4. Verify your doctors, hospitals, and prescriptions
Before selecting a new plan, check whether your preferred providers remain in-network. Also verify the plan’s prescription drug formulary (the list of covered medications).
A lower premium may not be the best value if the plan does not work for your doctors, hospitals, or medications.
5. Review the final price, not only the headline rate
The 15.97% average does not tell you what your monthly bill will be. Review the actual premium and financial assistance amount shown for your household on Pennie.
How Total Benefit Solutions can help
You do not have to interpret these rate changes alone.
Total Benefit Solutions is an independent, zero-cost health insurance advocate. We help individuals, families, and small employers review 2027 options, compare plans, evaluate networks and formularies, and understand how the approved rates may affect their coverage.
We can help you avoid an automatic renewal that no longer offers the best value. Our job is to help you navigate the available choices and fight for the best coverage at the best price. We never accept no when advocating for your benefits.
Visit https://www.totalbenefits.net or call (215) 355-2121 to discuss your 2027 options.
For official rate information, review the Pennsylvania Insurance Department’s 2027 ACA rate announcement and visit Pennie during Open Enrollment.
Educational disclaimer
Rates, financial assistance, plan availability, provider networks, and prescription drug coverage vary by carrier, county, and individual circumstances. This article is for general educational purposes and is not individualized insurance, legal, tax, or financial advice. Verify all information with Pennie and the applicable health plan before enrolling or changing coverage.
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