How much does health insurance cost per employee in Pennsylvania?

In Pennsylvania, the average employer-sponsored health insurance premium is approximately $756/month for single coverage and $2142/month for family coverage. Pennsylvania's cost index is 1.05 relative to the national average (1.00). Actual costs depend on group demographics, plan design, carrier, and funding type.

What health insurance funding types are available for Pennsylvania employers?

Pennsylvania employers can choose from fully insured, level-funded, self-funded, PEO (Professional Employer Organization), and MEWA arrangements. Each has different cost structures, risk profiles, and regulatory requirements.

Does Pennsylvania use a state or federal health insurance exchange?

Pennsylvania uses the Federal marketplace (healthcare.gov) for individual and small-group enrollment. Employers can also work directly with carriers or licensed brokers.

What is the annual premium trend in Pennsylvania?

The average annual premium increase trend in Pennsylvania is approximately 8.1%, based on recent market data. This varies by funding type - fully insured trends run 7-9%, level-funded 4-6%, and PEO arrangements 3-5%.

Pennsylvania Health Insurance
Cost Per Employee Calculator

Compare fully insured, level-funded, self-funded, PEO, and MEWA health plan costs for your Pennsylvania business -- powered by real data from KFF, CMS, and state DOI filings.

Pennsylvania Small-Group Health Insurance at a Glance

Avg Single Premium

$756/mo

Avg Family Premium

$2142/mo

Cost vs National Avg

+5%

Annual Trend

8.1%/yr

Exchange: Federal marketplace (healthcare.gov)

Medicaid Expanded: Yes

Top Carriers: Independence Blue Cross (Philadelphia), Highmark Blue Cross Blue Shield (Pittsburgh), UnitedHealthcare, Aetna, Cigna, UPMC Health Plan, Geisinger Health Plan

State Mandates: Standard ACA plus autism, diabetes, colorectal screening, mammography, and mental health parity mandates

Your Company

Tell us about your business so we can estimate health insurance costs using Pennsylvania-specific rates and demographics.

State ?Your business state determines rating rules, carrier availability, and cost indices. Pennsylvania has a cost index of 1.05 relative to the national average.Source: KFF 2025 State Health Facts

Industry ?Industry affects average employee age, salary mix, and expected utilization. Some industries qualify for association health plans or industry MEWAs.Source: BLS Quarterly Census of Employment

Eligible Employees ?Full-time equivalent employees eligible for benefits (30+ hours/week under ACA). The ACA requires employers with 50+ FTEs to offer coverage or face penalties.Source: IRS ACA Section 4980H

Average Employee Age ?Average age drives premium calculations via the ACA 3:1 age curve. A group averaging age 55 pays about 2.7x more than a group averaging age 21. Pennsylvania follows the federal 3:1 age rating curve.Source: CMS Federal Age Curve (45 CFR 147.102)

Coverage Tier Mix ?The distribution of employees across coverage tiers significantly affects total cost. National average: ~55% single, ~12% EE+spouse, ~33% family. Adjust to match your workforce.Source: KFF 2025 Employer Health Benefits Survey

% Single

55%

% EE+Spouse

12%

% Family

33%

Total: 100%

Current Situation

Tell us about your current health benefits arrangement so we can show how alternatives compare.

Currently offering health benefits? ?If you currently offer benefits, we'll compare your actual costs to alternatives. If not, we'll show estimated costs for each funding type.Source: BIH analysis methodology

Current Funding Type ?Your current arrangement determines your baseline cost and what alternatives may save you money. Most small employers (under 100 employees) use fully insured plans.Source: KFF EHBS 2025, Table 10.1

Current Monthly PEPM (Per Employee Per Month) ?Your current total premium cost per employee per month. Include both employer and employee portions. If unsure, the Pennsylvania average is ~$756/mo for single coverage.Source: KFF 2025 EHBS

Employer Contribution % ?Percentage of premium the employer pays. National average is 83% for single coverage and 73% for family. The ACA requires employer contribution to be "affordable" (employee share under 9.12% of household income in 2025).Source: KFF EHBS 2025; IRS Rev. Proc. 2024-35

75%

Compare Options

Select which funding types to compare and your preferred plan tier. We'll calculate costs for each based on Pennsylvania market data.

Funding Types to Compare ?Select multiple funding types to see a side-by-side comparison. Each type has different cost structures, risk profiles, and regulatory requirements.Source: BIH multi-funding analysis

Plan Tier Preference ?Metal tier affects both premiums and out-of-pocket costs. Bronze plans have the lowest premiums but highest deductibles; Platinum is the opposite. Silver is the most popular choice for small groups.Source: CMS MLR Standards (Bronze 60%, Silver 70%, Gold 80%, Platinum 90%)

Built on Real Pricing Data -- Not Guesswork

This tool is powered by actuarial and regulatory datasets, calibrated to 2026 market conditions.

📊

CMS Federal Age Curves

Official ACA 3:1 rating factors for every age 0-64+, plus state exceptions (NY, VT, MA, DC)

🗺

50-State Cost Indices

State-level premium multipliers reflecting provider costs, utilization patterns, and market regulation

📈

KFF EHBS Survey

Kaiser Family Foundation 2025 Employer Health Benefits Survey -- the gold standard for employer cost benchmarks

📉

Actuarial Claims Data

Expected claims from SOA and Milliman research, used for self-funded and large group pricing models

Calculation Methodology

Base Premium Calculation: We start with the KFF 2025 national average single premium ($720/mo) and apply the Pennsylvania cost index (1.05) to get the state-adjusted base rate. Age adjustments use the CMS 3:1 federal age curve, and tier mix multipliers convert single rates to blended PEPM costs.

Funding Type Adjustments: Fully insured rates include carrier margin (15-20%) and risk charges. Level-funded rates remove 8-12% of carrier margin but add stop-loss premium. Self-funded rates are pure expected claims plus admin fees (typically $30-50 PEPM) and stop-loss. PEO rates reflect group purchasing power (typically 14% below direct market). MEWA rates are similar to PEO but with association-specific pool dynamics.

Trend Projections: 3-year projections use funding-type-specific trend rates: fully insured (8.1%), level-funded (5.2%), self-funded (4.8%), PEO (3.8%).

Limitations: This calculator provides estimates based on market averages. Actual premiums depend on your specific group's claims history, plan design, carrier underwriting, and negotiated rates. Use this as a comparison starting point, then request actual quotes.

Want a Personalized Cost Analysis?

Get a detailed report with your specific numbers -- reviewed by a licensed benefits advisor.

What Pennsylvania Employers Need to Know About Health Insurance Costs

Pennsylvania has a cost index of 1.05, slightly above the national average. The state has two distinct major healthcare markets: the Philadelphia region (served by Independence Blue Cross) and the Pittsburgh region (served by Highmark BCBS and UPMC Health Plan).

The ongoing competition between Highmark BCBS and UPMC Health Plan in western Pennsylvania has created both challenges (network disruptions) and opportunities (competitive pricing) for employers in that region. Understanding the local market dynamics is critical for Pittsburgh-area employers.

Pennsylvania expanded Medicaid and uses the federal marketplace. The state's diverse economy -- from pharmaceutical companies in the Philadelphia suburbs to steel and energy in the west -- creates varied employer benefit needs.

Geisinger Health Plan, known for its innovative value-based care model, offers unique options in central Pennsylvania. PEO arrangements (14% average savings) and level-funded plans are popular alternatives for employers seeking cost management without sacrificing benefit quality.

Pennsylvania Continuation Coverage: State continuation: 9 months for employers with fewer than 20 employees. Federal COBRA applies to employers with 20+ employees.

Pennsylvania Health InsuranceCost Per Employee Calculator