Pennsylvania Health Insurance

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Individual and small group health insurance rates in Pennsylvania typically increase each year. The amount of the increase is determined by how much the insurer is requesting, and the amount that is ultimately approved after careful review by the Department (DOI). Any rate change must be fair and appropriate for both the carrier and consumer. Increased market share while retaining profitability and affordability for the consumer is the ultimate goal.

Prior to 2016, the general public could not view requests or findings unless the proposed increase was more than 10%. However, now you can view all results, regardless of the amount of change. And yes, sometimes, Pa health insurance prices reduce. Before a decision is made, several of the most important criteria include underwriting profits and losses, deducible and copay data, coverage changes, administrative fees, and historical and future predicted claim information.

Companies can choose weather to offer Exchange policies in specific states. Many carriers, such as Aetna, Cigna, and UnitedHealthcare, often provide plans is specific states, but also choose to “sit out” may others. Senior coverage, such as Medicare Supplement and Advantage plans, are treated separately.

We have listed below (courtesy of the DOI) the actual requested and approved changes submitted to the State Department of Insurance. These increases and decreases are reflected in 2016 Pa Marketplace plan coverage in the Keystone State.  Although many of the companies listed below, such as Highmark, Aetna, and UPMC write a large volume of business, many others issue a much lower number of policies, including Freedom Life and AmeriHealth.

Company                                   Requested Increase            Granted Increase

First Priority Life                           29.5%                                21.5%

Geisinger Health Plan                   40.6%                                20.0%

Geisinger Quality Options             58.4%                                20.0%

Highmark Individual                       25.5%                                20.1%

Highmark Small Group                  15.5%                                 9.9%

Highmark Benefits Group               13.5%                                9.9%

HM Health                                    35.9%                                26.2%

Keystone Health Plan West           36.6%                                26.7%

Aetna Individual                              5.6%                                 5.6%

Aetna Small Group                         6.1%                                 5.2%

AmeriHealth                                   6.77%                               6.88%

Capital Advantage Group                -2.4%                                -2.4%

Capital Advantage Ind.                    2.3%                                 1.6%

First Priority Life                             9.5%                                 9.5%

Freedom Life                                  9.9%                                 0.0%

Geisinger Small Group                    7.2%                                 7.2%

Geisinger Quality Options               9.88%                                9.88%

Health Assurance                           3.7%                                  1.9%

Highmark Advantage Group              9.7%                                 9.7%

HM Health                                      9.1%                                 9.1%

Inter-County Hospitalization             1.75%                               1.75%

Keystone Health Plan Central          -2.00%                              -2.00%

Keystone Health Plan East              2.8%                                 1.9%

Keystone Health Plan West             9.4%                                 9.4%

UnitedHealthcare Life                       9.1%                                3.5%

UPMC                                            0.0%                                0.0%