Pennsylvania Health Insurance Marketplace Guide

To be eligible to enroll in Pennsylvania Health Insurance Marketplace coverage, you must:

• Live in Pennsylvania
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance in the form of premium subsidies and cost-sharing reductions depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
• Not be eligible for Medicaid or CHIP, or premium-free Medicare Part A.⁸
• File a joint tax return, if married.⁹ (with very limited exceptions)¹⁰
• Not be able to be claimed by someone else as a tax dependent.¹¹
• Starting in 2027, non-U.S citizens will only qualify for subsidies if they’re lawful permanent residents (LPR), Cuban-Haitian entrants (CHE), or COFA migrants. No other immigration statuses will be eligible for subsidies at that point. ¹²

In Pennsylvania, the open enrollment period for 2027 individual and family coverage runs from November 1, 2026 to January 15, 2027.¹³

Note: A judge vacated the federal rule change that had required a shorter open enrollment period,¹⁴ which is why open enrollment for 2027 is continuing to follow the same schedule that was used in recent years.

Outside of open enrollment, you’ll need a special enrollment period (SEP) to enroll or make changes to your coverage. In most cases, a SEP requires a qualifying life event, but Native Americans can enroll year-round without a qualifying live event.

Pennsylvania also has an “easy enrollment” program that allows uninsured residents to begin the process of accessing health insurance via their state tax returns.⁴ Pennie confirmed by phone that about 900 people used Path to Pennie to obtain coverage in 2023, including Medicaid and private plans.

To enroll in an ACA Marketplace plan in Pennsylvania, you can: 

• Visit Pennie to enroll in Pennsylvania’s Marketplace. Here you will find an online platform to shop, compare plans and determine your subsidy eligibility. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor.

You may find affordable health insurance options in Pennsylvania by utilizing the state’s health insurance exchange – Pennie. Here, residents can enroll in health coverage as well as determine their eligibility for financial assistance.

During the open enrollment period for 2026 coverage, about 80% of Pennie enrollees qualified for premium tax credits (premium subsidies). These tax credits amounted to an average savings of $616/month. Subsidy-eligible enrollees paid an average of $145 per month for health coverage, after their subsidies were applied.¹⁵

In addition to premium tax credits, Marketplace enrollees with household incomes up to 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that result in lower out-of-pocket costs (deductible, coinsurance, copays) on Silver plans. During the open enrollment period for 2026 coverage, about 23% of Pennie enrollees selected plans with CSR benefits.¹⁵

Source: CMS.gov¹⁵

Between the premium subsidies and cost-sharing reductions, you’ll likely find that a plan obtained via Pennie provides you with the best overall value.

At some point, if state funding is allocated, Pennsylvania may start to offer additional subsidies, beyond the federal subsidies that are already available.¹⁶ But as of 2026, state funding had not yet been allocated for this purpose, so Pennsylvania is not among the states that offer additional state-funded subsidies.

Governor Shapiro’s proposed 2024-25 budget called for the state to create “an additional subsidy wrap” to make Pennie coverage more affordable for low-income and middle-income applicants.¹⁷

Legislation to create an “affordability assistance program” passed the Pennsylvania House in June 2024 and was sent to the Senate for consideration, but ultimately did not advance during the 2024 session.¹⁸ As a result, Pennie’s board of directors noted that funding for the state subsidy program was not available for plan year 2025.¹⁹ Funding was also not secured for 2026, and had still not been made available as of September 2026, making it unlikely that state subsidies will be available for 2027.

The 2024 legislation did not contain any specific parameters for how the subsidies would have worked (premium subsidies or cost-sharing reductions) or who would have been eligible for them. It only noted that the program should be designed “to incentivize enrollment in on-exchange policies based on income or other eligibility criteria.”²⁰

As of May 2024, the Pennie Board of Directors was recommending a sliding scale premium subsidy for gold and silver plans, for households earning between 151% and 300% of the federal poverty level.²¹

Pennsylvania officials have said that the state will be able to move forward with the subsidy program if the state can secure alternate funding for its reinsurance program, so that some of the funds currently being used for reinsurance can be diverted to the affordability assistance program.²²

Thirteen insurers will offer Marketplace coverage in Pennsylvania for 2027,¹ although several of them share parent companies:

• Ambetter Health of Pennsylvania
• Capital Advantage Assurance Company
• Geisinger Health Plan
• Geisinger Quality Options
• Health Partners Plans, Inc.
• Highmark Benefits Group
• Highmark, Inc.
• Keystone Health Plan East
• Oscar Health Plan of Pennsylvania
• Partners Insurance Company, Inc.
• QCC Insurance Company
• UPMC Health Network Inc. (formerly UPMC Health Options, Inc.)
• UPMC Health Plan, Inc.

Carriers have different coverage areas, so plan availability for 2027 varies by location.²³

The following average rate changes have been approved for 2027 for the insurers that offer Marketplace coverage in Pennsylvania, amounting to a weighted average increase of 16% (calculated before subsidies are applied).²⁴

Source: Pennsylvania Insurance Department²⁵

Average rate changes apply to full-price health plans, but the majority of Pennsylvania health insurance marketplace enrollees receive premium subsidies, and thus do not pay full price.¹⁵

Because federal subsidy enhancements expired at the end of 2025, net premiums increased significantly in 2026. Here are some examples of the sort of net premium increases that people saw in Philadelphia for 2026:²⁶

• 40-year-old earning $40,000:
  • Lowest-cost plan in 2025 was $41/month
  • Lowest-cost plan in 2026 is $116/month
• 60-year-old earning $63,000:
  • Lowest-cost plan in 2025 was $205/month
  • Lowest-cost plan in 2026 is $631/month

For perspective, here’s a summary of how average full-price premiums for Pennsylvania health insurance have changed over time:

• 2015: Average increase of 12%²⁷
• 2016: Average increase of 12%²⁸
• 2017: Average increase of 32.5%²⁹
• 2018: Average increase of 30.6%³⁰
• 2019: Average decrease of 2.3%³¹
• 2020: Average increase of 3.8%³²
• 2021: Average decrease of 3.3%³³
• 2022: Average increase of 0.2%³⁴
• 2023: Average increase of 5.5%³⁵
• 2024: Average increase of 3.9%³⁶
• 2025: Average increase of 6%³⁷
• 2026: Average increase of 21.5%³⁸

During the open enrollment period for 2026 coverage, 501,459 people signed up for private plans through the Pennsylvania Marketplace.¹⁵

Source: 2014,³⁹ 2015,⁴⁰ 2016,⁴¹ 2017,⁴² 2018,⁴³ 2019,⁴⁴ 2020,⁴⁵ 2021,⁴⁶ 2022,⁴⁷ 2023,⁴⁸ 2024,⁴⁹ 2025⁵⁰ 2026¹⁵

By September 2026, enrollment in Pennie plans stood at 417,158.⁵¹ Attrition has been higher than usual in 2026 (in Pennsylvania and nationwide) because of the decreased affordability that stemmed from the expiration of federal subsidy enhancements at the end of 2025.

Pennie
The official Pennsylvania health coverage Marketplace.

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]