Health Insurance Costs by State in 2026: A County-Level Analysis
We analyzed 479,910+ ACA marketplace plans across 3,051 U.S. counties to rank every state by the cost of health insurance in 2026.
Key Findings
- The cheapest state for Bronze coverage is Pennsylvania at $250/month — 34% below the national average.
- The most expensive state is West Virginia at $682/month — 80% above the national average.
- That means a 40-year-old in West Virginia pays roughly $5,177/year more than someone in Pennsylvania for a comparable Bronze plan — before subsidies.
- States with more insurer competition tend to have lower premiums. The cheapest 5 states average 40.7 insurers per county vs. 2.0 in the most expensive 5.
- Within-state variation can be dramatic: in Nevada, the cheapest Bronze premium varies by $263/month between the cheapest and most expensive counties.
5 Cheapest States for Health Insurance (2026)
| Rank | State | Avg. Bronze | Avg. Silver | Avg. Insurers | Plans |
|---|---|---|---|---|---|
| #1 | PennsylvaniaPA | $250/mo | $350/mo | 13.9 | 17,016 |
| #2 | IllinoisIL | $267/mo | $304/mo | 171.6 | 209,062 |
| #3 | MichiganMI | $268/mo | $331/mo | 9.0 | 9,810 |
| #4 | New HampshireNH | $271/mo | $318/mo | 4.0 | 230 |
| #5 | IndianaIN | $272/mo | $304/mo | 5.1 | 7,044 |
5 Most Expensive States for Health Insurance (2026)
| Rank | State | Avg. Bronze | Avg. Silver | Avg. Insurers | Plans |
|---|---|---|---|---|---|
| #49 | West VirginiaWV | $682/mo | $911/mo | 2.0 | 259 |
| #48 | AlaskaAK | $666/mo | $996/mo | 1.0 | 203 |
| #47 | WyomingWY | $651/mo | $872/mo | 1.0 | 240 |
| #46 | DelawareDE | $542/mo | $685/mo | 3.0 | 40 |
| #45 | ConnecticutCT | $512/mo | $579/mo | 3.0 | 374 |
States With the Biggest Premium Variation by County
Statewide averages can be misleading. In these states, the cheapest Bronze plan varies dramatically depending on which county you live in.
| State | Cheapest County | Most Expensive County | Spread |
|---|---|---|---|
| Nevada | $321/mo | $584/mo | $263/mo |
| Arizona | $295/mo | $546/mo | $251/mo |
| Montana | $285/mo | $491/mo | $207/mo |
| Maryland | $265/mo | $456/mo | $191/mo |
| California | $308/mo | $484/mo | $176/mo |
Complete State Rankings: Health Insurance Costs (2026)
Ranked by average lowest Bronze premium. All premiums are monthly, for a 40-year-old non-tobacco user.
| # | State | Avg. Bronze | Avg. Silver | Insurers | Plans | Medicaid |
|---|---|---|---|---|---|---|
| 1 | Pennsylvania | $250 | $350 | 13.9 | 17,016 | Expanded |
| 2 | Illinois | $267 | $304 | 171.6 | 209,062 | Expanded |
| 3 | Michigan | $268 | $331 | 9.0 | 9,810 | Expanded |
| 4 | New Hampshire | $271 | $318 | 4.0 | 230 | Expanded |
| 5 | Indiana | $272 | $304 | 5.1 | 7,044 | Expanded |
| 6 | Washington | $279 | $373 | 10.2 | 2,692 | Expanded |
| 7 | Iowa | $291 | $389 | 4.0 | 5,218 | Expanded |
| 8 | Idaho | $298 | $425 | 7.9 | 4,319 | Expanded |
| 9 | Virginia | $306 | $379 | 4.9 | 5,645 | Expanded |
| 10 | Minnesota | $309 | $359 | 4.8 | 5,436 | Expanded |
| 11 | Ohio | $314 | $402 | 11.6 | 14,936 | Expanded |
| 12 | Arizona | $316 | $359 | 5.6 | 1,286 | Expanded |
| 13 | South Carolina | $318 | $394 | 5.7 | 3,186 | No |
| 14 | Wisconsin | $321 | $456 | 12.4 | 14,381 | No |
| 15 | Missouri | $327 | $417 | 6.9 | 8,698 | Expanded |
| 16 | North Carolina | $328 | $427 | 8.4 | 10,129 | Expanded |
| 17 | Kentucky | $328 | $396 | 3.6 | 5,358 | Expanded |
| 18 | Colorado | $331 | $411 | 5.4 | 6,914 | Expanded |
| 19 | Texas | $336 | $440 | 16.7 | 50,914 | No |
| 20 | North Dakota | $339 | $482 | 3.0 | 1,343 | Expanded |
| 21 | Massachusetts | $345 | $418 | 7.5 | 608 | Expanded |
| 22 | Florida | $348 | $451 | 14.4 | 20,212 | No |
| 23 | Alabama | $351 | $490 | 2.8 | 2,551 | No |
| 24 | California | $354 | $403 | 8.5 | 3,972 | Expanded |
| 25 | New Mexico | $355 | $435 | 3.3 | 719 | Expanded |
| 26 | Oklahoma | $356 | $464 | 5.1 | 4,365 | Expanded |
| 27 | Louisiana | $362 | $462 | 4.7 | 3,363 | Expanded |
| 28 | Kansas | $363 | $469 | 5.9 | 7,386 | No |
| 29 | Tennessee | $365 | $465 | 5.9 | 7,741 | No |
| 30 | Maryland | $370 | $480 | 3.0 | 523 | Expanded |
| 31 | Georgia | $383 | $488 | 8.0 | 20,101 | No |
| 32 | Oregon | $391 | $480 | 3.4 | 994 | Expanded |
| 33 | New Jersey | $393 | $482 | 5.7 | 876 | Expanded |
| 34 | New York | $394 | $536 | 6.0 | 2,169 | Expanded |
| 35 | Utah | $400 | $499 | 6.5 | 1,636 | Expanded |
| 36 | Arkansas | $403 | $523 | 6.0 | 3,280 | Expanded |
| 37 | Hawaii | $414 | $533 | 2.0 | 34 | Expanded |
| 38 | Mississippi | $427 | $476 | 4.8 | 4,508 | No |
| 39 | Nebraska | $436 | $557 | 4.0 | 6,227 | Expanded |
| 40 | South Dakota | $436 | $549 | 2.3 | 1,917 | Expanded |
| 41 | Montana | $438 | $620 | 1.1 | 671 | Expanded |
| 42 | Maine | $457 | $538 | 2.7 | 477 | Expanded |
| 43 | Nevada | $460 | $539 | 4.0 | 820 | Expanded |
| 44 | District of Columbia | $483 | $526 | 3.0 | 27 | Expanded |
| 45 | Connecticut | $512 | $579 | 3.0 | 374 | Expanded |
| 46 | Delaware | $542 | $685 | 3.0 | 40 | Expanded |
| 47 | Wyoming | $651 | $872 | 1.0 | 240 | No |
| 48 | Alaska | $666 | $996 | 1.0 | 203 | Expanded |
| 49 | West Virginia | $682 | $911 | 2.0 | 259 | Expanded |
What Drives the Differences?
Health insurance premiums vary widely by state due to several factors:
- Insurer competition: Counties with more insurers competing for enrollees tend to have lower premiums. States with only 1-2 insurers in rural areas see much higher costs.
- State regulations: Some states mandate additional benefits beyond ACA minimums, which increases premiums. Others allow broader age rating bands or tobacco surcharges.
- Provider costs: Hospital and physician costs vary dramatically by region. Rural areas with fewer providers often face higher prices.
- Population health: The health profile of the enrolled population affects premiums. States with sicker or older enrollees see higher base rates.
- Medicaid expansion: States that expanded Medicaid cover more low-income residents through that program, leaving a healthier and potentially less costly exchange population.
How to Use This Data
These are pre-subsidy premiums. Most marketplace enrollees receive premium tax credits that significantly reduce their monthly costs. Use our Subsidy Calculator to estimate your actual cost after financial help.
Premiums shown are the lowest available in each metal tier — your actual plan selection may cost more depending on the insurer, network, and benefit design you choose.
To explore plan-level detail in your specific county, visit our state and county browser.
Cite This Research
LocalHealthPlanFinder. "Health Insurance Costs by State in 2026: A County-Level Analysis." LocalHealthPlanFinder.com, 2026-04-06. https://www.localhealthplanfinder.com/research/health-insurance-costs-by-state-2026
Find out what you would actually pay
These are pre-subsidy prices. Most people qualify for help — use our calculator to see your real cost.