Donna Gerhardt retired to East Stroudsburg, Pennsylvania, expecting to ease into her final years before Medicare eligibility. Instead, she is watching her monthly health insurance premium climb toward the unthinkable.
When federal Affordable Care Act subsidies expired at the start of 2026, Gerhardt’s payment on the state marketplace leapt from $576 a month to $1,495. Now her insurer, Ambetter, has asked the state to approve a 40.9% rate increase for 2027 — the highest of any carrier in Pennsylvania.
“No one’s getting a 40% salary increase or increase in their social security,” Gerhardt told WVIA News. “[…] Healthcare and taking care of your family and staying healthy or getting care if you’re sick shouldn’t be a luxury, and that’s what it is feeling like in this country.”
Gerhardt’s situation is extreme, but the direction is the same for almost everyone buying their own insurance in Pennsylvania. According to the Pennsylvania Insurance Department, insurers in the individual market have requested a weighted average rate increase of 17.1% for 2027. Small-group plans used by businesses with fewer than 50 employees face a proposed average increase of 11.5%.
The carriers requesting the sharpest hikes include Ambetter (40.9%), Highmark Benefits Group (21.4%), and Keystone Health Plan Central (33.8%). Even the most restrained proposals — Geisinger Health Plan at 10.5% — are asking for increases that outpace most wage growth.
Piled on Top of Premiums That Already Doubled
What makes this round of increases especially punishing is that it lands on top of a shock Pennsylvanians absorbed just nine months ago. When the federal enhanced ACA premium tax credits expired on Jan. 1, 2026 — after Congress failed to extend them — monthly premiums for Pennie enrollees rose an average of 102%, according to Pennie, the state’s ACA marketplace. Some residents found themselves paying more than $1,000 a month to stay insured.
The result has been a quiet coverage collapse. As of Aug. 10, 191,000 Pennsylvanians had canceled their Pennie coverage since the subsidies ran out, according to Pennie data. State insurance experts say many of those people are now going without coverage entirely.
“If these proposed rates take effect, even more Pennsylvanians are likely to be priced out of coverage,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network, in a statement to WHYY News. “Those who remain insured may have to switch to plans with higher deductibles or less coverage, or make painful cuts to other household expenses just to afford their monthly premiums.”
A National Picture of Financial Strain
Pennsylvania is not an outlier. Nationally, about 9% of Americans who were enrolled in ACA marketplace plans in 2025 are now uninsured, and another 17% say they are not confident they can keep affording their premiums, according to a KFF poll of 1,117 ACA enrollees conducted in February and March 2026. More than half — 55% — of those who did reenroll said they have cut or plan to cut spending on basic household expenses like food and clothing to cover their premiums.
By early January, about 1.5 million fewer Americans had signed up for 2026 ACA coverage compared to the same point the previous year, according to Centers for Medicare & Medicaid Services data. Urban Institute economists estimated at the time that 4.8 million people would ultimately lose coverage and become uninsured in 2026 as a direct result of the subsidy lapse.
State Review, Congress Stalled
The proposed Pennsylvania rates are not final. The state Insurance Department is reviewing the filings and negotiating with carriers; Commissioner Michael Humphreys said he hopes to finalize rates by the end of September — and by Nov. 1 at the latest, in time for open enrollment. Final premiums are typically lower than what insurers initially request.
But Humphreys acknowledged that the regulatory process has limits when the underlying drivers — hospital costs, drug prices, and the absence of federal help — remain unaddressed. He called on Congress to restore the subsidies.
“When you’re talking about almost 200,000 [Pennsylvanians] losing their coverage because … Congress failed to act, that’s a real hardship for a lot of individuals and families,” he told WVIA. A bill to extend the subsidies remains stalled in Congress, where most Republicans have opposed it and the Senate voted down a three-year extension in December.
Gerhardt said she will drop Ambetter before 2027 and hunt for something cheaper — if she can find it — for her one remaining year before Medicare eligibility kicks in.
“Having to accept the sad inevitability of the loss of the tax credits was huge,” she said. “This now 41% increase will just be greed — that’s what it feels like.”
Open enrollment on Pennie begins Nov. 1.