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 $21,600 per year for a single person) 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.

What plans cost in 2026

The Pennsylvania Insurance Department approved an average 21.5% rate increase for individual marketplace plans in 2026. Rates vary considerably by carrier: Highmark plans went up about 14.5%, while UPMC Health Plan increases ranged from 20% to 25% depending on the specific product. Independence Blue Cross plans in the Philadelphia area increased about 15%.

The bigger story is what happened to out-of-pocket costs. With the enhanced premium tax credits expiring, 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.

For people with incomes above roughly $62,600 (single) or $84,600 (couple), there are no longer any premium tax credits available. That group is paying full sticker price, which for a 50-year-old could mean $700 to $1,100 per month for a Silver plan depending on the region.

Carriers in Pennsylvania (2026)

Pennsylvania has 14 insurers on Pennie for 2026, the same count as 2025. 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 Shield covers 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 plans saw some of the larger rate increases for 2026 (20-25%).
• 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.
• Cigna offers plans in certain regions, and Jefferson Health 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, Cigna, 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 plans, subsidies, and rules are the same as the federal marketplace, but the website and customer service are state-run.

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.

PA has a high-risk pool alternative. Pennsylvania operates a state-funded program called adultBasic for certain low-income adults, though enrollment is limited. For most people, Pennie or Medicaid will be the better path. Contact your county assistance office if you need help figuring out which program fits.

Resources

• Pennie.com for 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