Health Insurance by State: How to Find the Best ACA Plan Where You Live (2026)
Published March 30, 2026 · Updated for 2026 open enrollment and subsidy changes
Finding affordable health insurance in 2026 just got harder. With enhanced ACA subsidies gone and the 400% FPL cliff back, your state matters more than ever. Where you live determines which marketplace you use, whether you qualify for Medicaid, how many insurers compete for your business, and ultimately how much you pay.
This guide breaks down what you need to know about health insurance in every state — from exchange types and Medicaid expansion status to average premiums and how to find the cheapest plan in your county.
Why Your State Matters More in 2026
Before 2026, enhanced subsidies under the American Rescue Plan kept premiums affordable nationwide. Now that those subsidies have expired:
- The 400% FPL cliff is back. If your income exceeds $62,600 (single) or $128,600 (family of 4), you get zero subsidy — and pay full price.
- Non-expansion states leave a coverage gap. In 10 states that haven't expanded Medicaid, people earning below 100% FPL ($15,650 for a single adult) may qualify for neither Medicaid nor marketplace subsidies.
- Insurer competition varies wildly. Some counties have one insurer and limited plan choices. Others have five or more, driving premiums down.
- State exchanges may offer extra benefits. States running their own marketplace sometimes provide additional subsidies, extended enrollment periods, or supplemental programs.
Use our subsidy calculator to see exactly what you'd pay based on your income, household size, and state.
Federal Marketplace vs. State-Based Exchanges
There are three types of ACA marketplaces:
HealthCare.gov States (30 states)
Most states use the federal marketplace at HealthCare.gov. You'll shop for plans, apply for subsidies, and enroll all in one place. States on HealthCare.gov include:
Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming.
State-Based Exchanges (17 states + DC)
These states run their own marketplace websites with their own enrollment systems:
- California — Covered California (coveredca.com)
- Colorado — Connect for Health Colorado
- Connecticut — Access Health CT
- District of Columbia — DC Health Link
- Idaho — Your Health Idaho
- Kentucky — Kynect
- Maine — CoverME.gov
- Maryland — Maryland Health Connection
- Massachusetts — Massachusetts Health Connector
- Minnesota — MNsure
- Nevada — Nevada Health Link
- New Jersey — GetCovered.NJ.gov
- New Mexico — beWellnm
- New York — NY State of Health
- Pennsylvania — Pennie
- Rhode Island — HealthSource RI
- Vermont — Vermont Health Connect
- Washington — Washington Healthplanfinder
Why it matters: State exchanges sometimes offer benefits the federal marketplace doesn't, like extended enrollment windows, state-funded subsidies, or easier Medicaid integration. Check your state's exchange website for any special programs.
Medicaid Expansion: The 10 States That Haven't Expanded
Medicaid expansion under the ACA covers adults earning up to 138% of the federal poverty level ($21,597 for a single adult in 2026). Forty states plus DC have expanded Medicaid, but 10 states have not:
- Alabama — No expansion. Coverage gap exists below 100% FPL.
- Florida — No expansion. Largest state by population without expansion.
- Georgia — Partial expansion to 100% FPL through Georgia Pathways (with work requirements).
- Kansas — No expansion. Legislature has considered but not passed expansion bills.
- Mississippi — No expansion. One of the highest uninsured rates in the nation.
- South Carolina — No expansion.
- Tennessee — No expansion despite TennCare being a well-known program.
- Texas — No expansion. Largest number of uninsured residents in the U.S.
- Wisconsin — Covers adults up to 100% FPL through a BadgerCare Plus waiver, but has not done full ACA expansion to 138%.
- Wyoming — No expansion.
If you live in a non-expansion state and earn below 100% FPL, you may fall into the coverage gap — too much income for traditional Medicaid, but too little for marketplace subsidies. Use our Medicaid calculator to check your eligibility.
State-by-State Highlights
North Carolina
North Carolina uses HealthCare.gov and expanded Medicaid in December 2023, extending coverage to roughly 600,000 additional residents. With expansion, adults earning up to 138% FPL ($21,597 single) now qualify for Medicaid. The state has strong insurer competition in urban counties like Mecklenburg (Charlotte) and Wake (Raleigh), but rural counties in western NC may have fewer options. Browse North Carolina health insurance plans by county.
Texas
Texas has the highest number of uninsured residents in the country and has not expanded Medicaid. If you live in Houston, Dallas, San Antonio, or Austin, you'll typically find more insurer competition and lower premiums than in rural areas. All Texas residents shop on HealthCare.gov. Texans earning above 100% FPL ($15,650 single) can access marketplace subsidies — but with the cliff back at 400% FPL, middle-income Texans face full-price premiums. Browse Texas health insurance plans by county.
Pennsylvania
Pennsylvania runs its own state exchange called Pennie (pennie.com). The state expanded Medicaid and has solid insurer competition in the Philadelphia and Pittsburgh metro areas. Pennsylvania also offers some of the more affordable Silver plans in the Northeast. Browse Pennsylvania health insurance plans by county.
Alabama
Alabama has not expanded Medicaid and uses HealthCare.gov. The state has one of the higher uninsured rates in the country. Insurer competition is limited in many counties, with some rural areas having just one or two carriers. Browse Alabama health insurance plans by county.
Montana
Montana uses HealthCare.gov and expanded Medicaid in 2016 through a waiver program. Despite being a rural state, Montana has maintained reasonable insurer participation. The state's Medicaid expansion has significantly reduced its uninsured rate. Browse Montana health insurance plans by county.
Maine
Maine runs its own exchange at CoverME.gov and expanded Medicaid in 2019. The state has worked to stabilize its individual market and keep premiums competitive despite a small population and high healthcare costs. Browse Maine health insurance plans by county.
How to Find the Cheapest Plan in Your County
Premiums, plan options, and insurer availability all vary by county — sometimes dramatically within the same state. Here's how to find the best deal:
- Start with your county page. We list every ACA plan available in all 3,143 U.S. counties. Find yours at our states directory and drill down to your county.
- Check your subsidy amount. Use our subsidy calculator to see how much the government will pay toward your premium. Remember: in 2026, the subsidy cliff is back at 400% FPL.
- Compare metal tiers. Don't automatically pick the cheapest premium. A slightly more expensive Silver plan may save you thousands in out-of-pocket costs, especially if you earn under 250% FPL and qualify for Cost-Sharing Reductions (CSRs).
- Consider a Bronze + HSA combo. For 2026, all Bronze and Catastrophic plans are HSA-eligible. If you're healthy and want to build tax-free savings, a high-deductible Bronze plan paired with an HSA (up to $4,400 individual / $8,750 family) can be a smart strategy.
- Check the provider network. The cheapest plan means nothing if your doctors aren't in-network. Verify before you enroll.
Use our Plan Match Quiz to get a personalized recommendation based on your health needs and budget.
Key 2026 Numbers to Know
| Item | 2026 Amount |
|---|---|
| FPL (1 person) | $15,650 |
| FPL (family of 4) | $32,150 |
| 400% FPL cliff (single) | $62,600 |
| 400% FPL cliff (family of 4) | $128,600 |
| Medicaid expansion threshold (138% FPL, single) | $21,597 |
| Out-of-pocket maximum (individual) | $10,600 |
| Out-of-pocket maximum (family) | $21,200 |
| HSA contribution limit (individual) | $4,400 |
| HSA contribution limit (family) | $8,750 |
| Employer affordability threshold | 9.96% of income |
What If You Miss Open Enrollment?
Open enrollment for 2026 plans has ended in most states, but you may still qualify for a Special Enrollment Period (SEP) if you've experienced a qualifying life event like:
- Losing other health coverage (job loss, aging off a parent's plan)
- Getting married or having a baby
- Moving to a new state or county
- Changes in household income that affect eligibility
Use our SEP Qualifier tool to check if you qualify for a special enrollment period right now.
Some state-based exchanges also offer extended enrollment windows — check your state exchange website for details.
The Bottom Line
Your state and county play a huge role in what you'll pay for health insurance in 2026. With enhanced subsidies gone, it's more important than ever to shop carefully, compare plans at the county level, and take advantage of every tool available to find affordable coverage.
Start by finding your state, then drill down to your county to see every plan available where you live. And always run your numbers through our subsidy calculator before choosing a plan — you might be surprised at what you qualify for.
This article is for informational purposes only and does not constitute insurance advice. Plan availability, premiums, and subsidy amounts vary by location and are subject to change. Always verify current information on your state's marketplace or HealthCare.gov.
Sources: Centers for Medicare & Medicaid Services (CMS), Kaiser Family Foundation (KFF), HealthCare.gov, state exchange websites.