PA marketplace rate increase for 2026, with another 17% proposed for 2027.
Roughly where the subsidy ends for one person / a family of four.
Full-price marketplace premiums in Pennsylvania rose 21.5% for 2026 with 17% more proposed for 2027, and healthy people leaving the pool pushes them higher. Full price is the price of guaranteed issue. If you don’t need guaranteed issue, you can shop in a different pool.
Bring your current quote or plan, everyone’s age, the medications in the house, and any diagnoses in the last five years. I’ll tell you straight whether you’d qualify for underwriting and what that number looks like next to the marketplace.
I’m Nathan Baughman, owner of BIG Benefits in Doylestown. The marketplace is priced for a pool that includes everybody, and if you’re paying full price and you’re healthy, you are the one funding it. There’s nothing wrong with that as a policy. There’s something wrong with not knowing you have another option.
Private, underwritten plan. This is the page where the wedge matters most. Answer a health questionnaire; if you’re in good shape, you get a plan priced on your health, not your income, with a major PPO network, a deductible you choose, a max out-of-pocket, an unlimited contract, guaranteed renewable to 65, enroll any month, cancel any time. For healthy high-income households this is frequently a very different number than the marketplace.
Marketplace at full price, structured well. If someone in the house has a condition that would be excluded, or you want ACA guarantees, then a bronze HSA-eligible plan on Pennie, with the self-employed deduction if you qualify for it, is the disciplined version of full price.
A blend. It’s common to put the healthy members of a household on a private plan and a family member with an ongoing condition on the marketplace. There’s no rule that says everyone has to be on one policy.
Group, if you own the business. If you have even a couple of employees, see the Small Teams page; a level-funded or reimbursement structure can move the cost to the business.
Full price is the price of guaranteed issue. If you don’t need it, shop the other pool. Bronze + HSA if you stay. Health shares aren’t insurance. Mix and match the household.
“Needed medical insurance and he walked us through various options and we came up with a plan with the coverage we needed and at a cost less than we expected.” — Mike D., Google review
Choosing silver or gold at full price. Without a subsidy, the metal tiers are just math. A bronze plan with an HSA (2026 limit $4,400 single / $8,750 family, plus $1,000 if you’re 55+) is often the better structure if you’re staying on the marketplace at all.
Buying a health share because it’s cheap. Health care sharing ministries are not insurance, they don’t guarantee payment, they have no max out-of-pocket, and there’s no state regulator behind them. Some people are happy with them. Know what it is.
Assuming your income is stuck. Business owners have more control over reported income than they think. Occasionally a household that’s just over the cliff can plan around it. That’s a conversation with me and your CPA, not a sales pitch.
1. Is there a maximum out-of-pocket? 2. Is it an unlimited contract? 3. Is it guaranteed renewable? If a plan uses words like “deductible” and “PPO network,” that doesn’t automatically make it actual health insurance. These three questions do.
Send me an age and a zip code and I’ll send back a general idea of what’s available in your area. Twenty minutes, no charge, no pressure. Happy to answer any and all questions so you can make the most informed decision for you, your family, or your business.
