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Pennsylvania health insurance marketplace guide 2023

13 insurers offer health plans through Pennie, the state-run exchange

Pennsylvania exchange overview

Pennsylvania uses a state-run health insurance exchange (Pennie) which has 13 participating insurers offering 2023 coverage. 

During open enrollment for 2022 coverage, 374,776 people enrolled in private individual market plans through the Pennsylvania exchange. For 2023 coverage, enrollment was slightly lower, at 371,516 people. 

Pre-subsidy marketplace rates in Pennsylvania were essentially flat for 2022, and increased by an overall average of 5.5% for 2023

Pennie and the PA Department of Revenue have created an “easy enrollment” program that was in use by early 2022.

Pennie will be a good resource for people who lose eligibility for Pennsylvania Medicaid or CHIP in 2023 when the pandemic-era pause on Medicaid disenrollments ends (starting in April 2023). Here’s more about how Pennsylvania is handling this process.

Frequently asked questions about Pennsylvania's ACA marketplace

Pennsylvania now operates its own fully state-run exchange, known as Pennie. But this was a transition after several years of using the federally-run exchange.

Pennsylvania enacted legislation (H.B.3/Act 42) in 2019 that called for the state to transition to running its own exchange platform and also create a reinsurance program to help to make coverage more affordable. Both took effect in 2021 (Pennie was operational as of the fall of 2020, for people to enroll in 2021 coverage).

Although Pennsylvania initially opted not to establish its own exchange, the state seriously considered establishing its own exchange in 2015, when the King v. Burwell lawsuit threatened premium subsidy access in states that didn’t run their own exchanges. But the Supreme Court ultimately upheld subsidies for people in states that used the federally-run exchange, so Pennsylvania continue to use for several more years. 



The open enrollment period for individual/family coverage runs from November 1 to January 15 in Pennsylvania. This includes plans sold through the exchange as well as plans obtained off-exchange.

Outside of open enrollment, a special enrollment period (SEP) is necessary to enroll or make changes to your coverage. In most cases, a special enrollment period requires a qualifying life event.

(For people who lose Medicaid in 2023 or early 2024 due to the end of the pandemic-era continuous coverage rules, Pennie will be an important source of coverage if the person isn’t eligible for an employer’s plan. Here’s more about how this.)

There are also some special enrollment periods, such as Pennie’s low-income SEP, enrollment opportunities for Native Americans, and the tax-time “Path to Pennie” (described in more detail below) that do not require specific qualifying events.

In addition, Medicaid enrollment is available year-round.

Pennsylvania’s state-run exchange, Pennie, has 13 participating insurers, although some share a parent company. But there are still eight distinct entities offering coverage, which was a record high for Pennsylvania’s exchange as of 2022. The following insurers offer plans through Pennie for 2023, with varying coverage areas:

  • Capital Advantage Assurance
  • Geisinger Health Plan
  • Geisinger Quality Options
  • Highmark, Inc.
  • Highmark Benefits Group
  • Highmark Coverage Advantage
  • Keystone Health Plan East (Independence Blue Cross HMO)
  • QCC Insurance Company (Independence Blue Cross PPO)
  • UPMC Health Coverage
  • UPMC Health Options
  • PA Health and Wellness
  • Oscar Health
  • Cigna

Pennsylvania’s exchange is fairly robust in terms of overall insurer participation, but it’s gone from having four or more insurers offering plans in every county in 2015, to several areas of the state having only one insurer option in 2018 and 2019.

Three carriers that participated in 2014 left the exchange, but four more — including giants Assurant (Time) and UnitedHealthcare — joined the exchange, making Pennsylvania among the many states where consumer choice increased for 2015. But Assurant ceased sales of new policies nationwide on Jun 15, 2015, and UnitedHealthcare exited the exchanges in most states, including Pennsylvania, at the end of 2016. United’s total exchange enrollment in Pennsylvania was 65,159 in 2015.

Aetna also left the exchange in Pennsylvania (and ten other states) at the end of 2016. Aetna insured about 31,000 exchange enrollees in Pennsylvania in 2016, all of whom needed to switch to a new plan during open enrollment for 2017 coverage. Aetna then exited the off-exchange market at the end of 2017. Freedom Life/National Foundation Life also exited the off-exchange market at the end of 2017, but the Pennsylvania Insurance Department confirmed that Freedom Life/National Foundation Life never marketed their plans and didn’t have any enrollees in 2017.

Geisinger Quality Option (PPO) stopped being available on-exchange as of 2017, although Geisinger Health Plan (HMO) continued to be available on-exchange (nationwide, insurers have trended towards offering HMOs and/or EPOs in the individual market, especially in the exchange, instead of PPOs). But for 2019, Geisinger Quality Options has returned to Pennsylvania’s exchange.

Keystone Health Plan Central also stopped offering plans in the exchange in 2017, according to the rate approval notice published by the Pennsylvania Insurance Department. They were not offering silver plans at all in the individual market in 2017, which is a prerequisite of offering coverage in the exchanges under ACA rules. As of 2019, Keystone Health Plan Central is continuing to only offer plans outside the exchange, although they have over 2,000 enrollees.

All of the insurers that offered plans in Pennsylvania’s exchange in 2018 continued to do so for 2019 — and several expanded their coverage areas — and Ambetter (Centene) joined the exchange. Ambetter from PA Health & Wellness is offering plans in the Philadelphia area (Bucks, Montgomery, and Philadelphia counties). Residents in nearly half of Pennsylvania’s counties had additional plan options for 2019. In 31 of Pennsylvania’s 67 counties, there were more health insurers offering coverage in the individual market in 2019 than there were in 2018. And in addition to a new entrant into the market, four of the five insurers already in the individual market expanded their coverage areas for 2019. Further, the number of counties with just one health insurer offering coverage in the individual market decreased from 20 to eight.

For 2020, all of the existing insurers remained in the exchange, and Oscar joined in the Philadelphia area. Highmark also expanded into 14 additional counties for 2020.

In Pennsylvania, Highmark’s individual market plans are available through several affiliates. One of them — Highmark Choice Company — discontinued its 2020 plans (which were offered on- and off-exchange) at the end of 2020 and is instead only offering one bronze plan outside the exchange for 2021. Highmark Choice Company’s filing indicated that they expected to have very low enrollment (only two members) in 2021. Approximately 3,720 enrollees who had Highmark Choice Company plans in 2020 needed to switch to another plan for 2021.

For 2022, Cigna joined Pennsylvania’s exchange, with plans available in the Philadelphia area. The same 13 insurers continued to offer coverage in 2023. 

Thirteen insurers offer individual market plans through Pennsylvania’s health insurance marketplace/exchange (Pennie) in 2023, although several of them share parent companies.

The insurers that offer plans through Pennie implemented the following average rate changes for 2023, amounting to an overall average increase of 5.5%:

  • Capital Advantage Assurance: 11.2% increase.
  • Geisinger Health Plan: 15.5% increase.
  • Geisinger Quality Options: 17% increase.
  • Highmark, Inc. (EPO and PPO): 9.1% increase.
  • Highmark Benefits Group: 13.2% increase.
  • Highmark Coverage Advantage: 4.3% increase.
  • Keystone Health Plan East (Independence Blue Cross HMO): 1.3% increase.
  • QCC Insurance Company (Independence Blue Cross PPO): 0.9% increase.
  • UPMC Health Coverage: 4.4% increase.
  • UPMC Health Options: 4.2% increase.
  • PA Health and Wellness: 4.9% increase.
  • Oscar Health: 8.4% increase.
  • Cigna: 4.8% increase.

Across the entire individual market, including the insurers that only offer plans outside the exchange, the average rate change amounted to an increase of 5.5% for 2023.

For perspective, here’s a look at how average premiums have changed in Pennsylvania’s exchange over the years:

  • 2015: Average increase of 10-12%: In 2014, rates for coverage in the Pennsylvania exchange were lower than the national average. As of November 2014, across 13 carriers, PricewaterhouseCooper was reporting an average premium increase of 10.4% in Pennsylvania for 2015.  And a Commonwealth Fund analysis found an average rate increase of 12% in the Pennsylvania exchange, across all plans and metal levels, for a 40-year-old non-smoker.
  • 2016: Average increase of 12%: The overall weighted average rate increase in the individual market amounted to 12%. The average subsidy in the Pennsylvania exchange in 2016 was $251/month (lower than the average of $290). But for people who qualified for premium subsidies in the Pennsylvania exchange, the average pre-subsidy premium was $396/month in 2016, which was exactly the average across the 38 states that use
  • 2017: Average increase of 32.5%: When the final rates were approved, the Pennsylvania Insurance Department noted that the average individual market rates (including off-exchange plans) would increase by 32.5% for 2017.
  • 2018: Average increase of 30.6%: The initial rate filings for 2018 were based on the assumption that funding for cost-sharing reductions (CSR) would continue in 2018. Some of the insurers revised their filings after HHS finalized risk adjustment data in July 2017, and rates were again revised based on the assumption that CSR funding would not continue (the Trump administration terminated funding in October 2012). Insurers in Pennsylvania added the cost of CSR to the premiums for on-exchange silver plans. Insurers were also able to create new off-exchange-only silver plans that don’t have the cost of CSR added to their premiums. The final average rate increase was 30.6% for 2018; it would have been in the range of 7.6% if CSR funding had been committed for 2018. The Pennsylvania Insurance Department and the CEOs of the five individual market insurers had sent a letter in April 2017 to HHS, asking the federal government to take swift action to ensure stability in the individual insurance markets, including continued enforcement of the individual mandate and continued federal funding for CSR. Ultimately, however, the loss of federal CSR funding ended up being a boon for many consumers, as insurers added the cost to silver plan rates, and that, in turn, resulted in larger premium subsidies for all subsidy-eligible enrollees.
  • 2019: Average decrease of 2.3%: Initially, in June 2018, Pennsylvania insurers filed plans with an overall rate increase of 4.9%. But they modified their rate filings in July, resulting in an overall average proposed rate increase of 0.7 percent, after the load to account for the cost of CSR was reduced somewhat. And when the rates were approved, some additional reductions resulted in rates decreasing by an average of 2.3%, although there was considerable variation from one insurer to another. But average benchmark premiums in Pennsylvania were an average of 15% lower for 2019 than they were for 2018. Premium subsidies are based on the cost of the benchmark plan, so average subsidies were smaller in 2019 than they were in 2018, for people whose income remained the same. For 2018, the average subsidy amount in Pennsylvania was $625/month, whereas it was $539/month in 2019. The Insurance Department’s summaries of the proposed and approved rates made it very clear that the federal government’s actions with regards to the ACA had been destabilizing, and highlighted the “Wolf Administration efforts to combat the effects of sabotage on health insurance markets by the federal government and specifically the Trump Administration to dismantle the Affordable Care Act (ACA).” Although overall average rates in Pennsylvania’s exchange declined slightly for 2019, they would have declined even more if the individual mandate penalty hadn’t been eliminated and if the Trump administration hadn’t expanded access to short-term plans and association health plans (AHPs). According to an analysis by the Urban Institute, the combined effect of those changes was expected to drive Pennsylvania premiums 19.2 percent higher in 2019 than they would otherwise have been.
  • 2020: Average increase of 3.8%. In July 2019, the Pennsylvania Insurance Department published the proposed rate changes for 2020. Pennsylvania’s insurance commissioner also announced that Highmark would be expanding its coverage area into 14 additional counties for 2020, and Oscar would be joining the exchange in the Philadelphia area (Bucks, Chester, Delaware, Philadelphia, and Montgomery counties). Once rates were finalized, the average increase stood at 3.8%, down from 4.6% that insurers proposed initially. Final approved rates for some insurers were slightly higher than the insurers had proposed, but the overall impact of the rate review process was a somewhat smaller overall average rate changes across the whole market.
  • 2021: Average decrease of 3.3%. Across the entire individual market in Pennsylvania, which includes five additional insurers that only offer plans outside the exchange, the overall average rate change was a decrease of about 3.3%. In the small group market, insurers implemented an average rate increase of 2.1%, down slightly from the proposed average rate increase of 2.3%.
  • 2022: Average increase of 0.22%: Across the entire individual market, including the insurers that only offer plans outside the exchange, the average rate change amounts to an increase of 0.22% for 2022.

More than 371,000 people enrolled in private plans through Pennie during the open enrollment period for 2023 coverage. This was a little lower than the prior year’s enrollment total. Although nationwide exchange enrollment hit another record high in 2023, the state-based exchanges (of which Pennie is one) saw their 2023 enrollment dip slightly lower than the prior year’s numbers. 

Here’s a summary of enrollment numbers during each year’s open enrollment period:

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Pennsylvania easy enrollment program (Path to Pennie) in use as of early 2022

Pennsylvania lawmakers considered House Bill 1030 in 2021, to create an “easy enrollment” program in Pennsylvania, much like the system that Maryland debuted in 2020, and which Colorado will start using in 2022. New Jersey lawmakers passed a similar bill in 2021.

Although Pennsylvania’s legislation did not advance, Pennie’s board of directors noted that the legal authority already existed for Pennie and the Pennsylvania Department of Revenue to implement an easy enrollment program. As of August 2021, the process of implementing the program was well underway, and the new program, dubbed “Path to Pennie,” was up and running in time for the 2022 tax filing season (for 2021 tax returns).

Pennsylvania’s easy enrollment program adds an optional new form (REV-1882) to the Pennsylvania state tax return. Uninsured tax filers can complete this form and include it with their tax return if they would like the Pennsylvania Department of Revenue to share their pertinent information with Pennie. The state noted that data transfer will happen in three batches during the tax filing season, starting in March.

Pennie will then use that information to create a Pennie account for the tax filer. Starting in late March, Pennie will begin sending notifications to these tax filers. The notifications will include an access code so that the person can log into their Pennie account, an estimate of the financial assistance for which they’re eligible, and a 60-day special enrollment period that the person can use to select a plan and get enrolled in coverage. (Medicaid and CHIP enrollment run year-round, so the special enrollment period is not necessary if they’re eligible for one of those programs. But open enrollment for private health plans ended in mid-January, so the special enrollment period is necessary if the person’s income is too high for Medicaid.)

State-run health insurance exchange, "Pennie," debuted in the fall of 2020

Pennsylvania residents no longer use Pennie — the new Pennsylvania Insurance Exchange — debuted in 2020, and residents began using it to enroll in 2021 health plans starting on November 1, 2020. Account information for people who were enrolled in 2020 plans through was migrated to Pennie in advance of open enrollment, enabling a fairly seamless transition. Because the state is now running its own exchange, it had the flexibility to extend open enrollment, which lasted an extra month in Pennsylvania, ending on January 15, 2021 (the following year, for 2022 coverage and beyond, the federal government also extended the open enrollment period for through January 15).

Pennie stems from legislation that Pennsylvania enacted in 2019, calling for the state to establish its own health insurance exchange that would be operational in time for the 2021 plan year. This move will save money and also gives the state significantly more control over its exchange.

In August 2019, Governor Wolf announced the appointees for the Pennsylvania Health Insurance Exchange Authority’s board of directors. The group was tasked with overseeing the implementation and operations of the state-run marketplace. Pennsylvania’s Insurance Commissioner, Jessica Altman, was initially the chair of Pennie’s board of directors, although she will become the CEO of California’s exchange as of March 2022. Zachary Sherman, who previously served as the director of Rhode Island’s health insurance exchange, is leading Pennsylvania’s exchange.

In November 2019, Pennsylvania’s exchange board approved a seven-year contract with GetInsured, the vendor that created the state’s exchange platform and is running the call center. GetInsured is the exchange vendor for several other state-run exchanges, including Nevada’s transition away from in the fall of 2019 and New Jersey’s transition to a fully state-run exchange in the fall of 2020.

In a press release in 2019, Governor Wolf’s office noted that the user fee that was being collected by the federal government (for the use of, the federal call center, etc.) amounted to $98 million in 2019. It was set at 3.5% of premiums in 2019, and although that dropped to 3% in 2020 (actually 2.5% for Pennsylvania, since the state had transitioned to a state-based exchange using the federal platform, as described below), it was still going to be $88 million (now $73 million) that Pennsylvania insurers — and thus, Pennsylvania insureds — had to send to the federal government to use the federally-run exchange.

Wolf’s office noted that the state-run exchange was expected to cost “as little as $30 million per year,” likely in the range of $30-$35 million per year. As described below, Pennsylvania is using the savings to fund the state’s portion of a reinsurance program that is reducing the cost of coverage for people who aren’t eligible for premium subsidies.

Pennsylvania already switched to having a state-based exchange on the federal platform (SBM-FP) as of the fall of 2019. This means Pennsylvania had taken responsibility for a variety of exchange functions and oversight, but used for enrollment (six other states had the same exchange model as of 2021). This change reduced Pennsylvania’s exchange user fee to 2.5% of premiums for 2020, instead of 3%. The state had indicated that they would likely keep the fee at 3% of premiums and use the excess for “any unexpected transition costs” that might arise as the state switched from to its own enrollment platform.

In addition to financial savings, states that run their own exchanges also have flexibility regarding their open enrollment schedules (Pennie’s first enrollment window continued until January 15, 2021, which is an extra month beyond what it would be if the state had continued to use, call center operations, and navigator grants. They also have much better access to enrollment data, which can be used to better understand enrollment trends and seek opportunities to better serve the state’s population (they publish a vast amount of enrollment data). Jessica Altman, Pennsylvania’s Insurance Commissioner, testified before the PA House Insurance Committee in May 2019 and outlined the myriad benefits of switching to a state-run exchange.

Pennsylvania's new reinsurance program took effect in 2021

In addition to the new state-run exchange, Pennsylvania also implemented a reinsurance program, and is funding the state’s portion of the cost of the reinsurance program with the savings (roughly $42-66 million) that come from switching to a state-based exchange. The state plans to keep a 3% exchange user fee assessed on insurers that offer plans in the exchange. The cost to run the state-based exchange will be covered by that fee, and the leftover revenue will be used to cover the state’s share of the cost for the reinsurance program.

The state published its 1332 waiver proposal for the reinsurance program in mid-November 2019, and submitted it to CMS in February 2020. It was approved in July 2020, and will be in effect from 2021 through 2025. The reinsurance program will reimburse insurers 60% of the cost of claims that fall between $60,000 and $100,000.

Actuarial modeling in the state’s proposed waiver indicated that with the reinsurance program in place, unsubsidized premiums in the individual market would be 4.9% to 7.5% lower in 2021 than they would otherwise have been. In announcing that the waiver proposal had been approved, Gov. Wolf clarified that premiums were expected to be 5% lower in 2021 than they would have been without reinsurance. The proposed rates that insurers filed for 2021 amounted to an average decrease of about 2.6% from 2020 rates, and the approved rates ended up being even lower, with an overall average decrease of 3.3%; without the reinsurance program, average rates would have increased instead.

Reductions in premiums primarily benefit people who pay full price for their coverage, as premium subsidies (for those who are eligible) rise and fall in line with premiums. With the reinsurance program in place, Pennsylvania estimated that the number of subsidized enrollees in the state’s individual market would remain roughly level from 2020 to 2021, but that the number of unsubsidized enrollees would grow by about 4,000 people. (Ultimately, the number of subsidized enrollees grew significantly, due to the American Rescue Plan‘s subsidy enhancements, which are in effect through at least 2025.)

The federal government will provide a substantial amount of pass-through funding for Pennsylvania’s reinsurance program. The state’s final waiver proposal projected total funding of about $139 million in 2021, with the federal government paying about $95 million of that via pass-through funding. But the actual federal funding for 2021 ended up being larger than anticipated, at more than $120 million. (Federal funding stems from the fact that when a reinsurance program results in lower premiums, the necessary premium subsidies are also lower, resulting in savings for the federal government; pass-through funding refers to the process of using a 1332 waiver to allow the state to use the savings, instead of having the federal government keep the money).

Pennsylvania health insurance exchange links

State Exchange Profile: Pennsylvania< The Henry J. Kaiser Family Foundation overview of Pennsylvania’s progress toward creating a state health insurance exchange.

Health Care Matters, Pennsylvania Office of the Attorney General
Serves Pennsylvania consumers with health-related problems.
(717) 705-6938 / Toll-free: 1-877-888-4877 (only in Pennsylvania)

Pennsylvania Consumer Assistance Program
Assists people with private insurance, Medicaid, or other insurance with resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 881-6388 / [email protected]

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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