Pennsylvania’s Insurance Department has finalized 2027 Affordable Care Act marketplace rates, and how much a household’s bill rises next year depends heavily on which insurer sells the plan. Ambetter Health of Pennsylvania’s approved increase is 35.1 percent, the steepest among the state’s marketplace insurers, while Oscar Health Plan of Pennsylvania’s approved increase is just 1.4 percent. Across every insurer in the individual market, the department approved an average increase of 15.97 percent, down from the 17.14 percent insurers had originally requested.
Ambetter’s approved increase reaches 35.1 percent
Ambetter Health of Pennsylvania requested a 40.9 percent increase for 2027, and the Pennsylvania Insurance Department’s rate release, published September 18, shows the department approved 35.1 percent instead. Even after that substantial reduction, Ambetter’s approved increase is still more than double the statewide individual-market average of 15.97 percent, meaning an Ambetter policyholder’s 2027 bill will rise far faster than a typical Pennsylvania marketplace customer’s bill will.
Inside the kit: 51 state Medicare cost-help packs and a medication and cost tracker are built for exactly this kind of insurer-by-insurer comparison, once a Pennsylvania household moves from the marketplace to Medicare. Open The Medicare Cost & Coverage Protection Kit to see Pennsylvania’s cost-help pack.
Oscar’s approved increase holds near flat at 1.4 percent
Oscar Health Plan of Pennsylvania asked for a 15.4 percent increase, and the department approved just 1.4 percent, the smallest increase among the insurers named in the release. In percentage-point terms, the gap between Oscar’s request and its approval is larger than the reduction applied to Ambetter’s filing, showing the department did not apply the same across-the-board cut to every insurer’s proposal.
Commissioner Humphreys on how the filings were reviewed
Pennsylvania insurers first proposed a statewide average individual-market increase of 17.1 percent back in July, according to the department’s July 23 announcement opening that filing’s public comment period. Insurance Commissioner Michael Humphreys said at the time that “PID’s team will be closely examining each filing to ensure rates are reasonable and justified,” and that the department would reject increases found to be “excessive, inadequate, or unfairly discriminatory.” Ambetter’s and Oscar’s final numbers, four months later, show that review in practice: one insurer’s request cut by 5.8 points, the other’s by 14.
The department denied $94.7 million in unjustified increases
Across every 2027 marketplace filing, the Pennsylvania Insurance Department denied a combined $94.7 million in what it determined were unjustified premium increases before finalizing this year’s rates, a figure also reported by BCTV the following week, on September 22. The commissioner’s office also noted that Pennsylvania insurers saw claims costs rise 13 percent year over year, with medical and prescription drug claims climbing a combined $845 million from 2024 to 2025, part of the justification insurers cited for this year’s requests.
How the other Pennsylvania insurers compare
Highmark requested a 16.2 percent increase and had it approved at 14.5 percent, a cut of 1.7 percentage points. Geisinger Health Plan requested 10.5 percent and was approved for 8.6 percent, a cut of 1.9 points and the lowest final increase among the state’s larger marketplace insurers apart from Oscar. UPMC Health Plan requested 15.8 percent and was approved for 13.5 percent, a cut of 2.3 points and close to the statewide individual-market average. Keystone Central’s approved increase is 33.4 percent, the second-highest in the state behind Ambetter, and Capital Advantage’s approved increase is 14.8 percent. Measured in percentage points shaved off each request, Oscar’s 14-point cut and Ambetter’s 5.8-point cut both dwarf the roughly two-point reductions applied to Highmark, Geisinger and UPMC, suggesting the department reserved its heaviest scrutiny for the filings it judged furthest out of line.
Why insurers say costs keep climbing
The claims-cost increase the commissioner’s office cited, 13 percent year over year with a combined $845 million rise in medical and prescription drug claims from 2024 to 2025, is the justification insurers pointed to across nearly every filing reviewed this cycle. That single year-over-year figure does not explain why Ambetter’s request ran so far above Oscar’s, since both companies operate in the same state under the same medical-cost trend; the gap instead reflects each insurer’s own enrollment mix, plan pricing history and how each priced risk when it first set its 2026 rates.
The small-group market and the enrollment window ahead
Pennsylvania’s small-group market, which covers plans sold to small employers rather than individuals, saw a statewide average approved increase of 10.28 percent, down from an 11.49 percent request, according to the same release. That leaves small-group premiums rising at roughly two-thirds the pace of the individual market’s 15.97 percent average, even though the department reviewed both markets under the same July-to-September timeline this year.
Open enrollment for 2027 individual marketplace coverage runs from November 1 through December 15, 2026, giving Pennsylvania households roughly six weeks to compare Ambetter’s 35.1 percent increase, Oscar’s 1.4 percent increase and every insurer between them. Pennsylvania runs its own exchange, called Pennie, rather than relying on the federal HealthCare.gov marketplace that most states use, and the Insurance Department’s September 18 release remains the most current official account of what each insurer will charge.
A 35.1 percent bill next to a 1.4 percent one, with no guide to which insurer fits
Comparing Ambetter’s 35.1 percent increase against Oscar’s 1.4 percent increase during Pennsylvania’s open enrollment window takes real legwork. Pennsylvania’s Insurance Department denied a large share of insurers’ requested increases as unjustified this year, but no notice bundles that same scrutiny with the separate Medicare premium review a household eventually faces once it ages into that program.
The Medicare Cost & Coverage Protection Kit collects the state Medicare cost-help pack for Pennsylvania alongside the prior-authorization appeal steps and a medication and cost tracker for comparing plans on the Medicare side.
Open Pennsylvania’s cost-help pack in The Medicare Cost & Coverage Protection Kit.
This article was written with AI assistance and reviewed by a human editor before publication.
