Pennsylvania Health Insurance: Pennie, Private Plans & 2027 Rates
Shopping for health insurance in Pennsylvania? The Pennsylvania Insurance Department has approved another round of premium increases for 2027, with individual-market rates increasing by an average of about 16%.
But the changes vary considerably by insurance company. Some approved average increases are in the single digits, while others exceed 30%. That makes 2027 an especially important year to compare your options before renewing.
We help self-employed workers, individuals, families, early retirees, and small business owners compare Pennie coverage with other available private options while looking at premiums, deductibles, provider networks, prescriptions, and total out-of-pocket exposure.
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Pennsylvania Health Insurance at a Glance
| Topic | What Pennsylvania Residents Should Know |
|---|---|
| Marketplace | Pennie, Pennsylvania's state-based health insurance Marketplace. |
| 2027 Open Enrollment | October 15 through December 15, 2026. |
| 2027 Coverage | December 15 is Pennie's final Open Enrollment deadline for coverage beginning January 1, 2027. |
| 2027 Individual Rates | Approved statewide weighted average increase of 15.97%. |
| 2027 Small Group Rates | Approved statewide average increase of 10.28%. |
| Individual Carrier Range | Approved average changes range from about 1.4% to 35.1%, depending on the insurer. |
| Federal Financial Help | Premium Tax Credits generally require household income between 100% and 400% of the federal poverty level plus other eligibility requirements. |
| Medicaid | Pennsylvania Medicaid covers qualifying adults up to approximately 138% of the federal poverty level. |
| New Medicaid Rules | Work requirements and six-month renewals begin January 1, 2027 for certain adults. |
What Is Pennie?
Pennie is Pennsylvania's official state-based health insurance Marketplace.
Pennsylvania residents use Pennie rather than HealthCare.gov to shop for Marketplace coverage, apply for federal Premium Tax Credits, and enroll in Qualified Health Plans.
Pennie Marketplace plans are ACA-compliant major medical insurance and include important consumer protections.
- Coverage for pre-existing conditions
- Essential health benefits
- Prescription drug coverage
- Preventive care
- Hospital and emergency coverage
- Annual limits on covered in-network out-of-pocket costs
- No medical underwriting for eligibility
Pennsylvania's Approved Health Insurance Rates for 2027
The Pennsylvania Insurance Department has completed its review of 2027 ACA individual and small-group health insurance rates.
The approved statewide weighted average increase for Pennsylvania's individual market is 15.97%.
That is lower than the 17.14% average increase insurers originally requested.
Pennsylvania regulators say their rate review eliminated nearly $95 million in requested premium increases that were not sufficiently supported.
2027 Pennsylvania Individual Health Insurance Rate Changes by Company
These are the approved average 2027 individual-market rate changes published by the Pennsylvania Insurance Department:
| Insurance Company | Approved Average 2027 Change |
|---|---|
| Oscar Health Plan of Pennsylvania | +1.4% |
| Geisinger Health Plan | +8.6% |
| UPMC Health Network | +9.7% |
| Geisinger Quality Options | +10.7% |
| UPMC Health Plan | +13.5% |
| Highmark Inc. | +14.5% |
| Capital Advantage Assurance Company | +14.8% |
| Keystone Health Plan East | +16.0% |
| Health Partners Plans | +18.3% |
| Partners Insurance Company | +18.8% |
| Highmark Benefits Group | +19.7% |
| QCC Insurance Company | +21.3% |
| Keystone Health Plan Central | +33.4% |
| Ambetter Health of Pennsylvania | +35.1% |
Someone currently enrolled with an insurer receiving a larger increase may find another plan more competitive, but changing insurers can also mean changing provider networks, prescription formularies, deductibles, and other benefits.
Why Pennsylvania Health Insurance Costs Have Increased
Pennsylvania residents buying their own health insurance experienced significant increases for 2026 and are now facing another increase for 2027.
The Pennsylvania Insurance Department approved an average individual-market increase of 21.5% for 2026, followed by the 15.97% average increase approved for 2027.
Pennsylvania regulators cite several factors behind current premium pressure, including:
- Higher medical costs
- Greater use of health care services
- Higher prescription drug spending
- Changes in the health of the insured population
- The expiration of enhanced federal Premium Tax Credits
Federal Marketplace Savings Changed After 2025
From 2021 through 2025, temporary enhanced federal Premium Tax Credits made Pennie coverage less expensive for many households.
Those enhanced credits expired after December 31, 2025. Pennie reports that the average premium paid by people maintaining coverage approximately doubled for 2026.
Federal Premium Tax Credits still exist, but the general income cap has returned.
For 2027 coverage, eligibility generally requires household income between 100% and 400% of the federal poverty level, along with the other federal eligibility rules.
One-Person Household
Based on the applicable 2026 federal poverty guideline, 400% of the federal poverty level is approximately $63,840.
Family of Four
Based on the applicable 2026 federal poverty guideline, 400% of the federal poverty level is approximately $132,000.
Pennsylvania Has Created a State Affordability Program — But Funding Matters
Pennsylvania has established a State Health Insurance Exchange Affordability Program that could provide additional premium assistance to eligible Pennie customers.
However, as of September 2026, Pennie says the program has not yet been funded.
Pennie's modeling suggests that a funded program could reduce costs for hundreds of thousands of current and prospective enrollees.
Pennie Open Enrollment for 2027 Has New Dates
Pennsylvania has shortened its annual Open Enrollment period beginning with 2027 coverage.
The 2027 Pennie Open Enrollment period runs from October 15 through December 15, 2026.
- October 15, 2026: Open Enrollment begins.
- December 15, 2026: Open Enrollment ends.
- Coverage selected during the Open Enrollment period is intended to begin January 1, 2027.
Outside Open Enrollment, you generally need a qualifying life event or another available Special Enrollment Period to enroll in Pennie coverage.
Self-Employed Health Insurance in Pennsylvania
We work with Pennsylvania tradespeople, consultants, real estate professionals, owner-operators, truck drivers, farmers, health care contractors, freelancers, small business owners, and other independent workers.
For self-employed households, one of the most important parts of using Pennie is estimating annual income accurately.
Use Expected Net Self-Employment Income
Pennie instructs self-employed applicants to estimate net self-employment income for the year of coverage, rather than simply using gross business revenue.
Update Income Changes
If business income changes significantly during the year, update your Pennie application so your estimated financial assistance reflects your current circumstances.
Understand MAGI
Marketplace financial assistance generally uses Modified Adjusted Gross Income.
Your tax return, business income, and certain adjustments can all affect that number.
Tax Planning Can Matter
Eligible retirement contributions, HSA contributions, and other tax adjustments may affect Adjusted Gross Income.
Check with your tax professional before making tax decisions primarily to affect Marketplace eligibility.
Pennie Plans vs. Other Private Health Coverage
Pennsylvania residents may also encounter health insurance and health-benefit products sold outside Pennie.
Those products do not necessarily provide the same protections as Pennie Qualified Health Plans.
Pennie Marketplace Plans
- ACA-compliant major medical insurance
- Coverage for pre-existing conditions
- ACA-required essential health benefits
- Defined annual out-of-pocket limits
- No medical underwriting for eligibility
- Federal Premium Tax Credits for eligible households
Other Private Coverage
- May be sold outside Pennie
- Some products may use medical underwriting
- Pre-existing-condition provisions may differ
- Benefits and exclusions can differ
- Provider networks can be structured differently
- Pennie Premium Tax Credits generally cannot be used
Your Pennsylvania County Can Change Your Options
Pennsylvania's health insurance market is highly regional.
The insurers and networks available around Philadelphia can be very different from those available in Pittsburgh, Central Pennsylvania, the Lehigh Valley, Erie, or northeastern Pennsylvania.
Before choosing a plan, check:
- Your primary care doctor
- Your specialists
- Your preferred hospitals and health systems
- Your regular prescriptions
- Your preferred pharmacy
- Nearby urgent care facilities
- Out-of-area care if you travel regularly
Pennsylvania Medicaid and Medical Assistance
Pennsylvania Medicaid is also commonly called Medical Assistance or MA.
Pennsylvania is a Medicaid expansion state. For 2026, Pennsylvania lists the income threshold for the expansion population at approximately 138% of the federal poverty guidelines.
Current Pennsylvania income guidelines list annual limits of approximately:
- $22,025 for a household of one
- $29,864 for a household of two
- $37,702 for a household of three
- $45,540 for a household of four
Pennsylvania Medicaid Rules Change January 1, 2027
Pennsylvania is implementing significant new federal Medicaid requirements beginning January 1, 2027.
Certain adults ages 19 through 64 who do not have a dependent child under age 14 and do not qualify for an exemption will need to meet a work and community-engagement requirement.
Affected adults can generally meet the requirement through at least 80 hours per month of qualifying activity.
Activities can include:
- Paid employment
- Volunteering or community service
- Job training
- School at least half-time
- A combination of qualifying activities
Pennsylvania also says the requirement can be met through an applicable monthly earnings standard.
Some Pennsylvania Medicaid Renewals Move to Every Six Months
Beginning in 2027, some adults ages 19 through 64 will have Medicaid eligibility reviewed every six months instead of once per year.
Pennsylvania says existing recipients generally move to the six-month schedule after completing their next renewal in or after February 2027.
What If You Lose Pennsylvania Medicaid?
Pennsylvania has created a coordinated process between Medicaid and Pennie.
If you complete your Medicaid renewal and are found ineligible, your information may be securely transferred to Pennie so that a Marketplace application can be created.
Losing Medicaid can also create a Special Enrollment Period. Pennie generally advises consumers to select a plan within 60 days of losing Medicaid coverage.
Missed Open Enrollment? Pennsylvania Has Path to Pennie
Pennsylvania has a state-specific program called Path to Pennie that can help connect uninsured residents with health coverage during tax season.
When filing a Pennsylvania state income tax return, an uninsured household can complete Form REV-1882 to request information about health coverage.
Pennsylvania then sends the information to Pennie, which can create an account and provide:
- An access code for the Pennie account
- An estimate of available financial assistance
- A special 60-day window to apply and enroll
Leaving a Job or Losing Employer Coverage?
Losing qualifying job-based coverage can create a Special Enrollment Period through Pennie.
Depending on your situation, you may compare:
- Federal COBRA
- Pennsylvania Mini-COBRA where applicable
- A spouse's employer-sponsored health plan
- Pennie Marketplace coverage
- Medicaid if eligible
- Other available individual coverage
COBRA can allow you to temporarily keep the employer coverage you already have, but the premium may increase substantially once the employer stops contributing.
Pennsylvania Health Insurance for Early Retirees
Retiring before age 65 can create several years between employer health insurance and Medicare eligibility.
Possible options may include:
- Pennie Marketplace coverage
- COBRA
- A spouse's employer-sponsored plan
- Other available individual coverage
Marketplace financial assistance makes income planning important because pensions, investment income, taxable retirement distributions, self-employment income, and other income can affect household MAGI.
Small Business Health Insurance in Pennsylvania
Pennsylvania's approved average small-group health insurance increase for 2027 is 10.28%.
That doesn't mean every employer's renewal will increase by exactly 10.28%. Actual costs vary by carrier, employee demographics, geography, plan design, and other rating factors.
Depending on the business, options worth comparing may include:
Traditional Group Coverage
Employer-sponsored group health insurance with eligible employees participating in the group plan.
Level-Funded Coverage
Certain employers may qualify for level-funded arrangements that combine employer funding with stop-loss protection.
Underwriting, plan structure, and refund provisions vary by carrier.
ICHRA
An Individual Coverage HRA can allow an employer to reimburse eligible employees for qualifying individual health insurance under applicable rules.
QSEHRA
Certain qualifying small employers that do not offer a group health plan may reimburse employees for qualifying individual premiums and medical expenses.
How We Help Pennsylvania Residents
Self-Employed & 1099 Workers
Tradespeople, consultants, real estate professionals, truck drivers, farmers, health care contractors, freelancers, business owners, and other independent workers.
Individuals & Families
We compare Pennie plans and other available coverage based on premiums, deductibles, providers, prescriptions, and financial-assistance eligibility.
People Paying Full Price
If you don't qualify for Pennie Premium Tax Credits, we can compare full-price Marketplace coverage with other available options.
People Losing Medicaid
We can help you understand your Pennie and other coverage options if Medical Assistance ends because of income or eligibility changes.
Early Retirees
We help people who need coverage before Medicare compare Pennie, COBRA, spouse coverage, and other available options.
Small Business Owners
We can discuss traditional group plans, level-funded coverage, ICHRAs, QSEHRAs, and additional employee benefits.
Serving Clients Across Pennsylvania
We work with Pennsylvania residents by phone and video, so you don't need to live near a local insurance office.
Philadelphia, King of Prussia, Norristown, West Chester, Bucks County and surrounding communities
Pittsburgh, Cranberry Township, Greensburg, Washington and surrounding communities
Allentown, Bethlehem, Easton and surrounding communities
Harrisburg, Lancaster, York, State College, Altoona and surrounding communities
Scranton, Wilkes-Barre, Pocono communities and surrounding areas
Erie and surrounding communities
Official Pennsylvania Health Insurance Resources
Pennie
Pennsylvania's official Marketplace for individual
and family coverage and federal financial assistance.
Visit Pennie →
Pennsylvania Insurance Department
Approved health insurance rates, insurer information,
consumer assistance, and complaints.
Visit Pennsylvania Insurance Department →
Pennsylvania Medicaid
Medical Assistance eligibility, applications,
renewals, and 2027 Medicaid changes.
Visit Pennsylvania Medicaid →
Path to Pennie
Pennsylvania's tax-season pathway for certain
uninsured residents to receive a special enrollment opportunity.
Learn About Path to Pennie →
Common Questions About Pennsylvania Health Insurance
What is Pennie?
Pennie is Pennsylvania's official state-based health insurance Marketplace.
Pennsylvania residents use Pennie instead of HealthCare.gov to shop for Marketplace coverage and apply for federal financial assistance.
How much are Pennsylvania individual health insurance rates increasing in 2027?
The Pennsylvania Insurance Department approved an average statewide weighted increase of 15.97% for the 2027 individual market.
Your actual premium change can be very different from the statewide average.
Which Pennsylvania insurer has the largest approved increase for 2027?
Among the individual-market insurers listed by the Pennsylvania Insurance Department, Ambetter Health of Pennsylvania has the largest approved average increase at approximately 35.1%.
Which insurer has the smallest approved increase?
Oscar Health Plan of Pennsylvania has an approved average increase of approximately 1.4%.
That does not necessarily make it the lowest-cost or most appropriate plan for every applicant, and availability varies by area.
When is Pennie Open Enrollment for 2027?
Pennie's 2027 Open Enrollment period runs from October 15 through December 15, 2026.
December 15 is the final regular deadline for 2027 Open Enrollment coverage.
Can I enroll in January 2027?
Not through regular Open Enrollment. Pennsylvania shortened the Open Enrollment period for 2027 coverage so that it ends December 15, 2026.
After that date, you generally need to qualify for a Special Enrollment Period or another available enrollment pathway.
Can I still get help paying for Pennie in 2027?
Federal Premium Tax Credits remain available for eligible households.
The enhanced tax credits that applied through 2025 expired, and the general federal income cap of 400% of the federal poverty level has returned.
What is 400% of the federal poverty level for 2027 Pennie coverage?
Based on the applicable 2026 poverty guidelines, 400% is approximately $63,840 for a one-person household and $132,000 for a household of four.
Income alone does not determine eligibility for Premium Tax Credits. Other federal rules also apply.
Can self-employed people use Pennie?
Yes. Freelancers, independent contractors, consultants, and other self-employed Pennsylvania residents can purchase individual coverage through Pennie.
Financial assistance is based on expected household income and other eligibility requirements.
What is Path to Pennie?
Path to Pennie is a Pennsylvania program that can connect uninsured state tax filers with a special opportunity to enroll in health coverage.
Eligible residents who complete Form REV-1882 with their state tax return can receive a 60-day enrollment window from Pennie.
How much are Pennsylvania small business health insurance rates increasing?
The Pennsylvania Insurance Department approved an average small-group increase of approximately 10.28% for 2027.
Individual employer renewals can vary substantially.
Does Pennsylvania Medicaid have work requirements in 2027?
Beginning January 1, 2027, certain adults ages 19 through 64 will need to meet work and community-engagement requirements unless an exemption applies.
Pennsylvania generally describes the requirement as at least 80 hours per month of qualifying activity.
Do Pennsylvania Medicaid renewals change in 2027?
Yes. Some adults ages 19 through 64 will move to Medicaid eligibility reviews every six months instead of once per year.
Can I get Pennsylvania health insurance outside Open Enrollment?
Possibly. A qualifying life event such as losing employer coverage, losing Medicaid, getting married, having a baby, or certain moves can create a Special Enrollment Period.
Medicaid applications are available year-round, and Path to Pennie provides another Pennsylvania-specific enrollment opportunity for certain uninsured tax filers.
Is private health insurance cheaper than Pennie?
It depends on the applicant and the type of coverage.
Some non-Marketplace products may have lower premiums for certain eligible applicants, but benefits, medical underwriting, exclusions, provider networks, and pre-existing-condition rules can differ.
Compare the actual coverage rather than choosing based solely on monthly premium.
Can you check whether my doctors are in network?
Yes. Give us the names of your doctors, specialists, preferred hospitals, prescriptions, and pharmacy when we compare coverage.
Can you help me if your office is in Arizona?
Yes. We are licensed in Pennsylvania and work with Pennsylvania clients remotely by phone and video.
Compare Your Pennsylvania Health Insurance Options for 2027
With approved individual-market increases averaging nearly 16%, major differences between insurance companies, new Pennie Open Enrollment dates, and Medicaid changes beginning in 2027, this is an important year to review your coverage carefully.
We'll help you compare available options, check your doctors and prescriptions, and understand the costs and coverage before you choose.
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