Single-digit increases in store for Pittsburgh-area 2025 Affordable Care Act rates

By Kris B. Mamula / Pittsburgh Post-Gazette

UPMC Health Plan will raise insurance premiums for individuals by 3.90% in 2025, according to an announcement Wednesday by the state Insurance Department, while Highmark Inc. will boost rates by 7.81% next year.

The average Affordable Care Act rate hike granted after review by the Insurance Department for 2025 was 6%, 2 percentage points lower than what insurers had requested earlier in the year.

UPMC, which markets its individual products under UPMC Health Options Inc., controls 21% of the statewide market while Highmark has a 14.37% share. UPMC’s individual coverage is not offered in Crawford County in 2025.

In the small group health insurance market, UPMC Health Coverage Inc. and UPMC Health Options Inc. received approval to raise rates by 6.17% and 6.86% respectively. Highmark Inc. was approved for a 8.71% premium increase and Highmark Coverage Advantage received approval for a 9.37% hike next year. All of the products are available in Western Pennsylvania.

Highmark and UPMC dominate Western Pennsylvania’s market for “Obamacare” health insurance.

“We appreciate the opportunity to hear directly from Pennsylvanians and strive to ensure commonwealth families have access to quality health insurance at an affordable price,” Pennsylvania Insurance Commissioner Michael Humphreys said in a prepared release.

Individual market coverage is sold through insurance brokers and the state’s health insurance marketplace, which is called Pennie. Open enrollment for Pennie health care coverage is held Nov. 1 through Dec. 15 for insurance starting Jan. 1, but certain family events and other life changes can allow sign ups at any time.

The state marketplace offers financial assistance to help lower monthly premiums and out-of-pocket costs, depending on the individual’s income. Most Pennie enrollees qualify for financial savings, which translates into average monthly savings of $500, according to the state.