Key Issue: Cost of Coverage
Spotlight on Affordability
80% of Pennsylvania’s uninsured are concerned about medical debt or financial crisis resulting from illness or injury, and 60% find Pennie’s plans unaffordable.
Pennie provides education on how premium costs affect Pennsylvanians, helping to shape health insurance affordability policies.
Maintaining Federal Premium Tax Credits
- Affordable and accessible health insurance for all eligible Pennsylvanians is a top priority for Pennie.
- As a result of federal policies to address affordability, Pennie has experienced an enrollment increase of 50% since 2021. Half a million Pennsylvanians are enrolled with Pennie.
- Federal Premium Tax Credits have been an important aspect of affordability for marketplace enrollees since the adoption of the Affordable Care Act.
- Since 2021, Enhanced Premium Tax Credits (EPTC) totaling $600 million annually were made available to make coverage more affordable for enrollees. These tax credits are set to expire December 31, 2025 unless Congress acts.
- If EPTCs are allowed to expire this year, the cost of coverage will increase in 2026 by an average of 82% for all enrollees, with many paying double, triple, or quadruple as much per month.
Enhanced premium tax credits have made affordable health coverage a reality for many Pennsylvanians for the first time. Without them, costs will rise sharply, forcing nearly half a million people to choose between their health and their financial security. Keeping these tax credits in place means Pennsylvanians can continue to access essential care and protect themselves from medical debt—benefits that ripple through our families, communities, and the entire healthcare system.
The Cost of Losing Enhanced Premium Tax Credits
Average Premium Increase by Income Level
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- Monthly costs for Pennie enrollees would increase by 82% on average.
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- Depending on income, some households would see their net premiums more than double.
Impacts By Congressional District
NOTE: Click on Congressional District for a worksheet of additional information for this specific region.
Cost Increases for Middle Age and Older Pennsylvanians
- Enrollees between the ages of 45 – 64 make up 50% of total Pennie enrollment.
- This age group makes up over 60% of enrollment in 22 counties.
- The counties with the highest enrollment in this age group are all rural.
Total Pennie Enrollment by Age Group
Using plan year 2025 data, the map shows the percentage of enrollees between the ages of 45 – 64 as compared to the total enrollment in the county.
Steep Hikes for Working Middle Class
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- While they make up a smaller share of Pennie enrollees, individuals earning over 400% of the Federal Poverty Level (about $60,000 annually) will face the steepest premium increases. These Pennsylvanians could experience net premium increases of double or quadruple what they currently pay.
- The enhanced premium tax credits ensure no family pays more than 8.5% of household income for coverage through Pennie – this will increase to over 40% of household income for some families.
Impacts to Entire Commonwealth
- Rural counties will experience a disproportionately high financial impact, as rural residents will lose more premium tax credit dollars than those in urban counties.
- Urban counties have more enrollees and are expected to have higher levels of disenrollment if the enhanced premium tax credits expire.
This map shows the average annual loss of advance federal premium tax credits per policy if the enhanced tax credits were to expire today.
Letters from Pennie to Federal Lawmakers
Pennie is educating Pennsylvania policymakers and stakeholders on the expected impacts of losing the enhanced premium tax credits. Preserving them is essential to safeguarding the health and financial well-being of Pennsylvanians across the Commonwealth. More details and supporting data can be found in the documents below.
June, 2025
Pennie & PA Insurance Dept. Letter to House Delegation on Reconciliation Bill
Pennie & PA Insurance Dept. Letter to Senate Delegation on Reconciliation Bill
September, 2024
Recent News and Statements on Affordability
NOTE: These are external links. By clicking on them you will be leaving Pennie’s website. Links to other websites are provided solely for the convenience of the user and do not constitute an endorsement or recommendation of those websites.
Establishing a State Health Insurance Affordability Program
Since opening our doors in 2021, Pennie has consistently heard that cost is a primary barrier to coverage for many uninsured Pennsylvanians. Pennie’s research shows that many uninsured individuals find health coverage to be unaffordable, despite the availability of federal tax credits. (Learn more: Pennie Uninsured Survey) These insights highlight the critical need for the Commonwealth to explore additional cost-assistance measures.
Pennie has partnered with state lawmakers to explore ways to reduce the cost of health coverage. As part of the 2024-2025 Pennsylvania State Budget, Pennie gained the authority to establish the State Health Insurance Exchange Affordability Program. Once funded, this program will provide premium assistance to eligible Pennsylvanians, making coverage more affordable. Pennie continues to engage with lawmakers and stakeholders, highlighting the importance of funding this program and the significant benefits it will deliver to Pennsylvanians.
How The State Affordability Program Helps:
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- Increases economic and financial security for individuals across Pennsylvania.
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- Improves health outcomes for enrollees with better and more consistent access to medical care.
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- Strengthens the individual health insurance market by improving the risk pool.
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Learn more about what our partners are saying about the need for a state subsidy program:
https://pahealthaccess.org/pa-organizations-release-letter-in-support-of-pennie-subsidies/