Pennsylvania Health Insurance Guide

Health Insurance Overview in Pennsylvania

Pennsylvania operates Pennie, a state-based marketplace launched in 2021. Pennsylvania expanded Medicaid (Medicaid expansion / PA Healthy Communities) in 2015. Pennsylvania has a competitive marketplace in Philadelphia and Pittsburgh with multiple insurer options. The state has implemented consumer assistance programs to help residents navigate coverage options.

Average Health Insurance Costs in Pennsylvania

Marketplace Enrollment in Pennsylvania

Pennsylvania residents can enroll in individual and family health insurance plans through Pennie (State-Based). Open enrollment runs November 1 – January 15 (Pennie).

Average Premiums by City in Pennsylvania

Medicaid in Pennsylvania

Pennsylvania Medicaid (Medical Assistance) expanded in 2015, covering adults with incomes up to 138% of the federal poverty level.

Children's Health Insurance (CHIP) in Pennsylvania

CHIP covers children under 19 in families with incomes up to 314% of the federal poverty level.

What Makes Pennsylvania Unique

Pennsylvania launched Pennie in 2021, transitioning from the federal marketplace to a state-based exchange. Pennie has focused on improving user experience and enrollment assistance. Pennsylvania's marketplace benefits from competition in its major metropolitan areas — Philadelphia and Pittsburgh both have multiple insurers offering plans.

ACA Subsidies: What Pennsylvania Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

Pennsylvania’s Marketplace for 2027: Insurers, Rates, and Dates

Pennsylvania residents enroll through Pennie. Full-price premiums rose about 21.5% on average for 2026, before subsidies. 14 insurers sold plans for 2026. Proposed 2027 changes average about 16% before subsidies.

About 501,000 people enrolled for 2026. About 80% received premium tax credits, and the average net premium after credits was about $145 a month.

What’s Different About Health Coverage in Pennsylvania

Pennsylvania runs its own exchange, Pennie, with 14 insurers — one of the most competitive markets in the country. A reinsurance program created under Act 42 (2021) lowers full-price premiums. A state subsidy has been proposed but not funded. Pennsylvania offers easy enrollment through the state tax return.

Tips for Choosing Health Insurance in Pennsylvania

Pennsylvania residents should enroll through Pennie (not HealthCare.gov) to access any state-specific programs and assistance. Medical Assistance Medicaid covers low-income adults. Philadelphia and Pittsburgh benefit from competitive insurer options. CHIP provides children's coverage up to 314% of the federal poverty level.

• Enroll during open enrollment (November 1 – January 15 (Pennie)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.

Frequently Asked Questions

How many insurers sell marketplace plans in Pennsylvania?

Fourteen insurers sold Pennsylvania marketplace plans for 2026, with proposed 2027 changes averaging about 16% before subsidies.

How much do Pennsylvania marketplace enrollees pay after subsidies?

In 2026 about 80% of Pennsylvania enrollees received premium tax credits, and the average net premium was about $145 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official Pennie (State-Based) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.