Insurance Department Releases 2023 Proposed ACA Rates and Health Plans

Acting Pennsylvania Insurance Commissioner Michael Humphreys today released the 2023 requested rate filings for insurance plans under the Affordable Care Act. As filed, 2023 will see increased competition and more choices for consumers within some counties. Both the individual and small group rate requests will result in a moderate statewide average increase.

“As we navigate through the aftermath of the COVID-19 pandemic, Pennsylvania continues to have a strong and competitive insurance market,” said Humphreys. “Increased choices and plan options will provide Pennsylvanians with the opportunity to shop for the best coverage options for themselves and their families.”

Insurers offering plans in the individual market filed plans requesting an average statewide increase of 7.1 percent. Insurers that currently sell in Pennsylvania’s small group market filed plans requesting an average statewide increase of 5.2 percent.

Similar to other states’ filings, insurers are attributing the proposed increases to multiple factors including but not limited to:

  • rising health care costs
  • projected claims due to deferred care resulting from the pandemic
  • increases in medical and drug utilization and cost trends
  • the ending of the American Rescue Plan Act (ARPA) enhanced subsidies

As currently filed, of Pennsylvania’s 67 counties, no county will lose an on-exchange insurer. For Plan Year 2023, within the individual market, one county will gain a new on-exchange insurer. Ambetter (from PA Health & Wellness) will enter the Berks County individual market for Plan Year 2023. Within the small group market, five counties gained a new insurer. Cigna + Oscar will enter the small group market in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.

Looking to Plan Year 2023, every county in Pennsylvania will have more than one insurer in the individual market and more than one on-exchange insurer. This is consistent with Plan Year 2022, when the increased competition among multiple insurers has provided consumers with more options to make the best decision for individuals, as well as families.

The federal American Rescue Plan’s financial assistance saw out-of-pocket premium costs borne by Pennsylvanians decrease by an average of 9 percent. Many families who believed that comprehensive health care coverage was beyond their reach were able to purchase plans that provided quality care as a direct result of the ARPA subsidies. However, if these subsidies are allowed to expire, Pennsylvanians will see out-of-pocket costs increase, and coverage for many may become unaffordable.

“The Wolf Administration has worked toward ensuring all Pennsylvanians have access to the care they need during the COVID-19 pandemic and beyond, and in 2022, Pennsylvania saw the lowest uninsured rate in history, at 5.4 percent, thanks in large part to the affordability and access of coverage offered by the American Rescue Plan enhanced subsidies,” said Humphreys. “We cannot afford to slow or lose this progress.”

Humphreys continued, Congress must extend ARPA subsidies to ensure families are able to purchase or maintain affordable coverage. We are hopeful that the subsidy extension being discussed in the U.S. Senate quickly becomes law, providing time for the Department to review any necessary impact on, or modifications to, filed rates.”

Nearly 375,000 Pennsylvanians enrolled in health coverage through the Commonwealth’s official marketplace, Pennie®, during the last Open Enrollment period, an 11 percent increase compared to 2021. This includes more than 35,000 middle-income individuals who for the first time qualified for financial assistance to lower the cost of health coverage by an average of $252 per month.

The Pennsylvania Insurance Department is committed to thoroughly analyzing the requested rates to hold them to the standards of not being excessive, inadequate, or discriminatory, in keeping with the department’s mission to meet the needs of Pennsylvania’s health insurance consumers.

The deadline to submit rate filings for 2023 health insurance plans to the Insurance Department was June 1, 2022. Proposed rate changes vary by plan and region and are subject to change as the department conducts its review process. Final approved rates will be made public in the fall.