500K in Pa. face soaring health care premiums as insurers seek rate hikes

Nearly 500,000 Pennsylvanians could see their health insurance premiums spike next year.

Insurers selling coverage on the state’s Affordable Care Act marketplace, Pennie, want to raise premiums by an average of 19% for customers who buy their own insurance and 13% for small businesses, the Pennsylvania Insurance Department announced Friday.

The department reviews proposed rates to make sure they’re not too high, too low or discriminating against certain groups of customers.

Companies are asking for much higher hikes than last year, when the average proposed increase came in at 8% for the individual and small business markets.

“This year, even more than previous years, Pennsylvanians should consider shopping around to find the best plans to meet their individual needs, at a price that makes sense for their current financial situation,” Pennsylvania Insurance Commissioner Michael Humphreys said in a statement.

Western Pennsylvania’s dominant health insurers, UPMC and Highmark, are requesting below average — but still substantial — hikes.

UPMC is seeking increases for individuals of between 12% and 16%. For Highmark, that range is 14% to 18%.

On small business plans, UPMC is asking to raise premiums between 7% and 9%.

Highmark’s requests for such plans, on the other hand, fall between 12% and 23% — the highest of any insurer in the state.

The Highmark plan that could see the highest increase covers the northeastern part of Pennsylvania.

UPMC and Highmark made $237 million and $15 million respectively in the first quarter of this year.

Financial health will be just one factor the Insurance Department uses to approve or adjust rates.

It also looks at past rate changes, cost estimates and consumer impacts, according to its website.

Past filings show regulators usually trim requests for individual plans and make limited revisions on small business plans, which can be bought by companies with 50 or fewer employees.

Occasionally, regulators approve a higher-than-requested rate.

Regulators blame rising health care costs, higher utilization of medical services and the upcoming end of the enhanced premium tax credit to help customers afford insurance on the ACA marketplace.

Pennie claims its enrollees save around $600 million annually through the expiring program.

To justify its desired hikes, Highmark cited the same factors as the Insurance Department as well as pent-up demand for care after the pandemic.

“We are committed to offering the high-quality coverage and experience that our Pennsylvania ACA members and small group employers have come to expect from Highmark,” David Golebiewski, a Highmark spokesperson, said in a statement.

Denise Hughes, a UPMC spokesperson, said the organization is “committed to continued work with the Insurance Department to continue to make affordable, high quality coverage options for consumers.”

A company-by-company, plan-by-plan list is available on the Insurance Department’s website.

Public comment on rate requests runs through Sept. 2 and can be emailed to ra-in-comment@pa.gov.

The Insurance Department did not return a request for comment.

Jack Troy is a TribLive reporter covering business and health care. A Pittsburgh native, he joined the Trib in January 2024 after graduating from the University of Pittsburgh. He can be reached at jtroy@triblive.com.