States with the Most Expensive Health Plan Premiums
All states ranked by average monthly premium for a 27-year-old — the most expensive health insurance markets.
What This Ranking Tells Us
Health insurance premiums on the ACA marketplace vary significantly by state, driven by local healthcare costs, provider networks, state regulations, and the competitive landscape of insurance issuers. States topping this list often have limited issuer competition, higher hospital and physician costs, or older and less healthy enrollment pools. The age-27 benchmark premium is the standard comparison point used by researchers and policymakers because it represents the base rate before age adjustments.
What the Data Reveals Across 30 States
This ranking covers 30 states and jurisdictions in the ACA marketplace. West Virginia tops the list at $844, while New Hampshire sits at the opposite end with $391. The median value across all ranked states is $568, giving a rough sense of where a typical state lands relative to the extremes. The spread between top and bottom — $453 — illustrates how unevenly this particular metric is distributed across the country.
Rankings of this kind are shaped by a mix of structural factors: issuer competition, hospital and physician pricing, whether a state expanded Medicaid (which affects who enrolls in marketplace plans vs Medicaid), state-specific benefit mandates, and the age and health profile of each state's enrollment pool. Two states with similar demographics can still post very different numbers because of marketplace design choices and regulatory posture. The figures shown here are base rates — most enrollees pay less after Advance Premium Tax Credits are applied, with subsidy size keyed to each county's benchmark (second-lowest Silver) premium.
Use this ranking as a starting point for state-level comparison, not as a personalized recommendation. Your actual premium, deductible, and out-of-pocket exposure depend on age, household income, tobacco use, county of residence, and the specific plan you choose. Click any state to drill into county-level data, and always verify final pricing, provider networks, and subsidy eligibility at HealthCare.gov before enrolling. This page is informational only and is not insurance, medical, or tax advice. Source: CMS ACA Marketplace Public Use Files, Plan Year 2026.
| # | State | Avg Premium |
|---|---|---|
| 1 | West Virginia WV | $844 |
| 2 | Wyoming WY | $841 |
| 3 | Utah UT | $791 |
| 4 | Nebraska NE | $729 |
| 5 | Florida FL | $728 |
| 6 | Alaska AK | $720 |
| 7 | Mississippi MS | $641 |
| 8 | North Carolina NC | $609 |
| 9 | Louisiana LA | $608 |
| 10 | Kansas KS | $602 |
| 11 | Delaware DE | $586 |
| 12 | Tennessee TN | $583 |
| 13 | Texas TX | $575 |
| 14 | Arkansas AR | $570 |
| 15 | Oklahoma OK | $568 |
| 16 | Arizona AZ | $562 |
| 17 | Montana MT | $556 |
| 18 | Wisconsin WI | $551 |
| 19 | Missouri MO | $548 |
| 20 | South Dakota SD | $546 |
| 21 | Alabama AL | $539 |
| 22 | Oregon OR | $529 |
| 23 | Michigan MI | $525 |
| 24 | Ohio OH | $520 |
| 25 | Indiana IN | $510 |
| 26 | South Carolina SC | $500 |
| 27 | North Dakota ND | $499 |
| 28 | Hawaii HI | $463 |
| 29 | Iowa IA | $458 |
| 30 | New Hampshire NH | $391 |
Source: CMS ACA Marketplace Public Use Files, Plan Year 2026.
Frequently Asked Questions
Why are premiums higher in some states?
Premium costs reflect the underlying cost of healthcare in each state. Key factors include hospital and physician prices, the number of insurance companies competing (more competition generally lowers prices), state-specific benefit mandates beyond federal requirements, the health status of the enrolled population, and whether the state expanded Medicaid (which affects who enrolls in marketplace plans).
Are subsidies available to reduce premiums?
Yes. Advance Premium Tax Credits (APTCs) are available to households earning between 100-400% of the Federal Poverty Level. Enhanced subsidies have been extended through at least 2025, making marketplace coverage affordable for most eligible enrollees. The actual out-of-pocket premium after subsidies can be significantly lower than the listed premium.
Is the age-27 premium what everyone pays?
No. ACA premiums are adjusted by age, with a 3:1 ratio allowed — meaning the oldest enrollees pay at most 3 times what the youngest adults pay. A 60-year-old can expect to pay roughly 2.5-3x the age-27 rate. Family premiums are calculated by adding each covered member's age-adjusted premium. Tobacco users may be charged up to 1.5x more in most states.
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Read our methodology — how this data is sourced, computed, and verified.