Pennsylvania’s ACA Marketplace Reports Significant Coverage Loss
Pennsylvania’s Affordable Care Act Marketplace shared on Monday that approximately 85,000 individuals who enrolled in low-cost plans in 2025 did not renew their coverage this year. This drop follows the expiration of the expanded tax credits that previously helped lower costs for consumers.
With premiums increasing, on average, prices have doubled. This situation has resulted in about one in five Pennsylvanians losing their health insurance, as indicated by the state’s marketplace, Penny.
On a somewhat positive note, around 79,500 new participants brought the total number of enrollees to a record high, making health insurance available to more people. However, overall enrollment fell to 486,000 in 2026, down from 496,661 at the close of last year’s enrollment period. The agency cautioned that this trend could decline further in the coming months since there’s typically a three-month grace period after premiums are no longer paid before coverage officially ends. The deadline for applications was January 31.
Currently, about 700,000 residents in Pennsylvania lack health insurance, according to recent census reports. The agency had predicted last summer that if Congress did not extend the enhanced tax credits introduced during the pandemic, nearly 150,000 people could lose their coverage.
Increasing Costs for Consumers
Last year, Penny indicated that out-of-pocket costs for people benefiting from the enhanced tax credits were projected to double, on average.
Individuals earning less than 400% of the federal poverty level—around $64,000 for single individuals and $132,000 for a family of four—are eligible for sliding scale tax credits to help reduce their monthly premiums. Since this tax credit is part of the legislation, it didn’t expire at the end of December. The changes affect a 2021 expansion that capped costs at 8.5% of income for those purchasing insurance through the marketplace.
Once that cap is lifted, a 60-year-old couple with an income of about $85,000 could see their premiums soar to approximately $22,600 this year, compared to just $7,225 last year, according to the Bipartisan Policy Center.
The issue of tax credits was a major aspect of last year’s federal budget discussions, leading to the longest government shutdown in history. While Democrats aimed to make the enhanced subsidies permanent, Republicans ultimately opposed this move.
Weak Coverage
Additionally, roughly 33,000 Penny customers opted for plans with lower monthly premiums but higher out-of-pocket costs, such as increased deductibles and copays. This represents a 30% rise in the number of people choosing bronze plans.
Penny further observed that rural areas were disproportionately affected by the decline in health insurance coverage. Fifteen of the top 20 counties experiencing the highest rates of disenrollment were rural, according to their data.
This trend can lead to added pressure on rural hospitals as people increasingly turn to emergency departments for care without the financial resources to cover expenses.
