Top 10 US Counties with Highest ACA Premiums in 2026

Findings

843.74 Highest Average Premiums

West Virginia recorded the highest average silver premium at 843.74 dollars during 2026 according to CMS QHP Landscape Files. This figure surpassed the prior year value of 814.50 dollars while 37 plans operated across the state. Aleutians West county in Alaska registered a silver premium peak of 865.74 dollars with exactly 8 plans total supplied by a single issuer. Aleutians East county in Alaska posted a gold average of 778.15 dollars drawn from 3 plans issued by Premera Blue Cross. Wyoming counties reached gold premiums as high as 982.81 dollars across 23 plans from major issuers.

West Virginia maintained the top position with 2 issuers delivering premiums that averaged 843.74 dollars over 37 plans in 2026 per HHS Health Insurance Exchange Data. Aleutians East county logged a silver average of 857.44 dollars that reflected a 5.44 percent year-over-year increase from 2025. Aleutians West county documented 8 plans carrying an average deductible of 4393.75 dollars above the national benchmark. West Virginia catastrophic plans averaged 8062.50 dollars in out-of-pocket maximum across 2 issuers.

Key Trends in Top Counties

Alaska counties such as Aleutians East exhibited 1 issuer dominating silver premiums above 865.74 dollars. Aleutians West county listed 2 silver plans with minimum premiums of 849.14 dollars from Premera. Wyoming posted an average premium of 841.34 dollars involving 2 issuers that covered 23 plans in the highest ranked areas. West Virginia highest premiums included gold values reaching 977.11 dollars maximum within selected subregions.

Alaska Aleutians East county maintained 3 gold plans averaging 778.15 dollars that signaled market concentration. Wyoming counties sustained gold premiums up to 982.81 dollars through 23 plans. West Virginia sustained 37 plans at the 843.74 dollar silver average while Aleutians West county held 8 plans at the 4393.75 dollar deductible level. Aleutians East county recorded the 857.44 dollar silver average after the documented 5.44 percent rise.

Implications for Issuers

Premera Blue Cross supplied the 3 plans that produced the 778.15 dollar gold average in Aleutians East county. The same issuer contributed the 2 silver plans that started at the 849.14 dollar minimum in Aleutians West county. West Virginia relied on 2 issuers to support the 843.74 dollar silver average across 37 plans. Wyoming engaged 2 issuers to administer the 23 plans that reached the 982.81 dollar gold level.

Market concentration appeared when 1 issuer handled premiums above 865.74 dollars in Aleutians East county. The 8 plans in Aleutians West county carried the 4393.75 dollar average deductible. Catastrophic coverage in West Virginia reached the 8062.50 dollar out-of-pocket maximum under 2 issuers. These issuer patterns align with the 841.34 dollar average premium observed in Wyoming top areas.

Methodological context

CMS supplied the QHP Landscape Files that serve as the upstream agency source for all 2026 premium observations. The agency follows a defined release cadence that issues annual snapshots each fall prior to open enrollment. Subsequent vintages flag revisions through updated file timestamps and version indicators that allow tracking of corrections to prior submissions. The snapshot vintage captured in Data.healthcare.gov Plan Year 2026 Records differs from any live API endpoint because the API may incorporate post-publication amendments while the static files preserve the original submitted values.

Coverage edges exclude certain territories and fully insured employer plans because federal exchange reporting statutes apply only to qualified health plans offered through state or federal marketplaces. Counties without at least 2 plans per metal level fall outside the analytic scope to maintain statistical reliability. The data pipeline ingests raw submissions then normalizes fields such as premium amounts and deductible values without alteration to the source figures. Public records terminology distinguishes the initial filing vintage from any later revision vintage that may appear in subsequent releases.

Researchers locate additional county-level detail through the Aleutians East County Details page. State aggregates appear on the Alaska State Overview page. Broader premium orderings reside on the Premium Rankings Page while issuer participation metrics reside on the Issuers Directory. The 2022-2026 Premium Trends page describes how revision history affects longitudinal comparisons across multiple file vintages.

Limitations surface when issuers withdraw plans after the snapshot date because those changes register only in later API pulls rather than the archived landscape files. Cross-referencing the methodology page clarifies that all numeric entries trace directly to the cited CMS and HHS sources without interpolation. Pipeline documentation further explains the normalization steps applied to premium and deductible columns to ensure consistent units across states.

The 2026 vintage incorporates filings received through the final submission deadline yet omits any mid-year plan terminations that occur outside the exchange reporting window. Analysts therefore consult both the static files and the current API when evaluating the most recent status for any given county.

West Virginia silver premiums at 843.74 dollars alongside Aleutians West silver values at 865.74 dollars and Aleutians East gold values at 778.15 dollars together illustrate concentrated issuer activity across 37 plans in one state and 8 plans plus 3 plans in two Alaska counties while Wyoming gold figures reached 982.81 dollars over 23 plans. These observations from CMS QHP Landscape Files and HHS Health Insurance Exchange Data connect directly to the methodological constraints of snapshot vintages release cadence and coverage edges that exclude entities outside marketplace reporting requirements.