Pennsylvania Insurance Department Releases Affordable Care Act 2027 Health Insurance Rates

The Pennsylvania Insurance Department (PID) approved final 2027 ACA premium rates for Pennsylvania's individual and small group markets on September 18, 2026. The approved average rate increase for the individual market is 15.97%, down from the originally requested 17.14%. The approved average rate increase for the small group market is 10.28%, down from an initial average request of 11.49%. Through its rate review process, PID denied $94.7 million in unjustified premium increases across the individual and small group markets. PID actuaries required insurers to trend actual 2025 and 2026 expenses and to justify projections for 2027 market conditions. Pennsylvania's individual and small group market insurers paid $845 million more in 2025 medical and prescription drug claims than in 2024, a 13 percent year-over-year increase in claims costs. PID identified two federal policy developments as contributing to upward rate pressure for 2027. Congress did not reauthorize enhanced premium tax credits for 2026 and beyond, which PID states caused individuals to drop coverage and increased uncompensated care obligations on medical providers. The July 2025 federal budget law (H.R. 1) added Medicaid work requirements and new enrollment paperwork, which PID projects will result in additional uninsured Pennsylvanians in 2027. Approved individual market rates by insurer range from a 1.4% increase (Oscar Health Plan of PA, reduced from a requested 15.4%) to a 35.1% increase (Ambetter Health of Pennsylvania Inc., reduced from a requested 40.9%). In several instances PID approved rates above what insurers originally requested: Health Partners Plans Inc. was approved at 18.3% versus a requested 15.9%, Keystone Health Plan East at 16% versus 14.7%, and QCC Insurance Company at 21.3% versus 19.9%, each reflecting risk adjustment or worsening medical and drug trend data confirmed after initial filing.