Health Insurance in Pennsylvania

Medicaid in Pennsylvania

Pennsylvania expanded Medicaid in 2015 under Governor Tom Wolf. Adults with household incomes up to 138% of the federal poverty level (about $22,025 per year for a single person for 2027 coverage) can enroll in Medicaid managed care. There is no POWER Account or cost-sharing requirement like Indiana's program. Coverage is comprehensive and includes dental for adults, which not all state Medicaid programs offer.

Medicaid enrollment in Pennsylvania grew substantially during the pandemic-era continuous enrollment provision and has since declined as the state completed its redetermination process. If your income is near the 138% FPL cutoff, you should apply through Pennie. The system will route you to Medicaid automatically if you qualify.

Open Enrollment for 2027

Pennie's Open Enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027. Enroll by December 15, 2026, for coverage that starts January 1, 2027. If you enroll between December 16 and January 15, coverage starts February 1, 2027.

What plans cost in 2027

The Pennsylvania Insurance Department approved an average 15.97% rate increase for individual market plans for 2027, down from the 17.14% insurers requested. That follows an average 21.5% increase for 2026. Approved 2027 changes vary widely by insurer, from 1.4% for Oscar to 35.1% for Ambetter Health of Pennsylvania. Highmark Inc. was approved for 14.5%, UPMC Health Plan for 13.5%, and Geisinger Health Plan for 8.6%.

KFF puts Pennsylvania's average benchmark Silver premium for a 40-year-old at $648 a month for 2027, up from $572 in 2026. That is the price before any tax credit.

Out-of-pocket costs have already jumped. With the enhanced premium tax credits expiring after 2025, Pennie reported that enrollee costs roughly doubled on average to keep the same plan. An unprecedented 85,000 people, about one in five enrollees, chose to drop coverage during 2026 Open Enrollment. Total Pennie enrollment ended up around 486,000, a 2% decline from 2025.

The enhanced credits were not extended for 2027. If your household income is above 400% FPL (about $63,840 for a single person or $86,560 for a household of two), you do not qualify for any premium tax credit and pay the full sticker price.

Carriers in Pennsylvania (2027)

The Insurance Department approved 2027 individual market rates for 14 insurance companies, several of which belong to the same parent (Highmark, Independence, UPMC, Geisinger, and Capital Blue Cross each file under more than one company). The state's market is fragmented by region because of the major health system rivalries, especially between UPMC and Highmark in western Pennsylvania:

• Independence Blue Cross (IBX) dominates the Philadelphia region (southeastern PA). IBX plans include the major Philadelphia health systems: Penn Medicine, Jefferson Health, and Temple. If you live in the Philly metro, IBX typically has the broadest local network.
• Highmark Blue Cross Blue Shieldcovers central and western Pennsylvania. In Pittsburgh, Highmark and UPMC had a long contract dispute that limited which UPMC hospitals were in Highmark's network. That dispute has largely been resolved, but verify specific UPMC facilities before enrolling in a Highmark plan.
• UPMC Health Plan is tied to the massive UPMC hospital system and is strongest in the Pittsburgh area. If your doctors are at UPMC facilities, this is often the most straightforward choice in western PA. UPMC Health Plan was approved for a 13.5% increase for 2027.
• Geisinger Health Plan covers 41 counties across central and northeastern Pennsylvania, anchored by the Geisinger Health System. Strong option if you live in the Wilkes-Barre, Scranton, Danville, or State College areas.
• Capital Blue Cross serves central Pennsylvania including the Harrisburg, Lancaster, and York areas.
• Ambetter (PA Health and Wellness) offers lower-premium plans with narrower networks. Available in multiple regions across the state.
• Oscar Health operates in select Pennsylvania markets and appeals to people who prefer a tech-forward, app-based insurance experience.
• Jefferson Health Plans (Health Partners Plans) serves the Philadelphia area with networks built around the Jefferson Health system.

Key regions

Philadelphia and southeastern Pennsylvania

The most competitive region in the state. Independence Blue Cross, Oscar, Ambetter, and Jefferson Health Plans all operate here. Philadelphia has some of the highest benchmark Silver premiums in Pennsylvania, which means larger subsidies for eligible enrollees. The city also has a dense network of Federally Qualified Health Centers and navigator organizations that offer free enrollment help.

Pittsburgh and western Pennsylvania

The UPMC vs. Highmark rivalry defines this market. UPMC Health Plan gives you access to UPMC hospitals and doctors. Highmark gives you access to Allegheny Health Network (AHN) facilities and has rebuilt some UPMC access through newer agreements. If you split care between UPMC and AHN providers, check both networks carefully before picking a plan.

Central Pennsylvania (Harrisburg, Lancaster, York)

Capital Blue Cross and Highmark are the primary carriers. Geisinger is available in some of these counties. Penn State Health (Hershey Medical Center) and WellSpan Health are the major hospital systems. This area generally has lower premiums than Philadelphia or Pittsburgh.

Northeastern Pennsylvania (Scranton, Wilkes-Barre)

Geisinger is a strong option here, with its integrated health system covering the region. Highmark also operates in these counties. The area has a higher proportion of older enrollees than southeastern PA, which can push premiums up.

Estimate your subsidy

Pennsylvania-specific things to know

Pennie is a state-based exchange, not HealthCare.gov. You enroll at pennie.com, not healthcare.gov. If you go to HealthCare.gov and enter a Pennsylvania address, it will redirect you to Pennie. The federal tax credit rules are the same, but Pennie sets its own enrollment dates and runs its own website and customer service (844-844-8040).

The UPMC-Highmark network situation.If you are in western Pennsylvania and care about having access to specific UPMC hospitals or doctors, always verify your plan's provider directory before enrolling. The network landscape has shifted multiple times in the past few years and not all UPMC facilities are in all Highmark products.

New immigrant eligibility rules for 2027. Starting January 1, 2027, federal premium tax credits and cost-sharing reductions are limited to U.S. citizens and nationals, green card holders, Cuban and Haitian entrants, and COFA migrants. Other lawfully present immigrants can still buy a plan through Pennie, but at full price. If this affects your household, ask a Pennie-certified assister or your county assistance office about Medicaid and other options.

Resources

• Pennie.comfor marketplace enrollment (Pennsylvania's state-based exchange)
• PA Department of Human Services for Medicaid eligibility and enrollment
• Pennsylvania Health Access Network for free consumer assistance and enrollment help