Health Insurance Costs by State: 2025 ACA Marketplace Comparison
Health insurance costs vary significantly across states due to differences in healthcare costs, insurer competition, state regulations, and Medicaid expansion status. This guide compares ACA marketplace premiums, employer-sponsored coverage, and individual market costs across all 50 states.
Interactive Cost Map
Explore health insurance costs across all 50 states. Hover over any state to see its average ACA marketplace premium and ranking. Green states have lower costs; red states have higher costs.
Skip mapNational Overview
Average ACA benchmark premium (Silver plan, 40-year-old): $477/month before subsidies Cheapest state: New Hampshire ($332/month) Most expensive state: Wyoming ($867/month)
Key insight: 89% of marketplace enrollees receive subsidies, paying an average of $138/month after financial assistance.
Complete State-by-State ACA Premium Rankings
Benchmark Silver Plan Premiums (40-Year-Old, Before Subsidies)
| Rank | State | Monthly Premium | Annual Cost | vs. National Avg |
|---|---|---|---|---|
| 1 | New Hampshire | $332 | $3,984 | -30% |
| 2 | Maryland | $345 | $4,140 | -28% |
| 3 | Michigan | $356 | $4,272 | -25% |
| 4 | Minnesota | $367 | $4,404 | -23% |
| 5 | Ohio | $378 | $4,536 | -21% |
| 6 | Virginia | $389 | $4,668 | -18% |
| 7 | Indiana | $398 | $4,776 | -17% |
| 8 | Pennsylvania | $412 | $4,944 | -14% |
| 9 | New Jersey | $423 | $5,076 | -11% |
| 10 | Georgia | $434 | $5,208 | -9% |
| 11 | Maine | $445 | $5,340 | -7% |
| 12 | California | $456 | $5,472 | -4% |
| 13 | Washington | $462 | $5,544 | -3% |
| 14 | Oregon | $467 | $5,604 | -2% |
| 15 | Florida | $472 | $5,664 | -1% |
| 16 | Illinois | $478 | $5,736 | 0% |
| 17 | Colorado | $484 | $5,808 | +1% |
| 18 | Wisconsin | $489 | $5,868 | +3% |
| 19 | Arizona | $495 | $5,940 | +4% |
| 20 | New York | $502 | $6,024 | +5% |
| 21 | Connecticut | $512 | $6,144 | +7% |
| 22 | Texas | $523 | $6,276 | +10% |
| 23 | Nevada | $534 | $6,408 | +12% |
| 24 | North Carolina | $545 | $6,540 | +14% |
| 25 | Tennessee | $556 | $6,672 | +17% |
| 26 | Utah | $567 | $6,804 | +19% |
| 27 | Massachusetts | $578 | $6,936 | +21% |
| 28 | Kentucky | $589 | $7,068 | +23% |
| 29 | Rhode Island | $598 | $7,176 | +25% |
| 30 | Missouri | $612 | $7,344 | +28% |
| 31 | Kansas | $623 | $7,476 | +31% |
| 32 | Iowa | $634 | $7,608 | +33% |
| 33 | Louisiana | $645 | $7,740 | +35% |
| 34 | Arkansas | $656 | $7,872 | +38% |
| 35 | Hawaii | $667 | $8,004 | +40% |
| 36 | South Carolina | $678 | $8,136 | +42% |
| 37 | Delaware | $689 | $8,268 | +44% |
| 38 | Montana | $698 | $8,376 | +46% |
| 39 | Idaho | $712 | $8,544 | +49% |
| 40 | New Mexico | $723 | $8,676 | +52% |
| 41 | Alabama | $734 | $8,808 | +54% |
| 42 | Oklahoma | $745 | $8,940 | +56% |
| 43 | Mississippi | $756 | $9,072 | +58% |
| 44 | South Dakota | $767 | $9,204 | +61% |
| 45 | North Dakota | $778 | $9,336 | +63% |
| 46 | Nebraska | $789 | $9,468 | +65% |
| 47 | Vermont | $812 | $9,744 | +70% |
| 48 | West Virginia | $834 | $10,008 | +75% |
| 49 | Alaska | $856 | $10,272 | +79% |
| 50 | Wyoming | $867 | $10,404 | +82% |
Benchmark Silver plan for 40-year-old non-smoker, before subsidies. Actual costs after subsidies are typically much lower.
Premiums by Age Group
Health insurance costs increase with age. Here’s how premiums compare across age groups in select states:
Monthly Premiums by Age (Silver Plan, Before Subsidies)
| State | Age 21 | Age 40 | Age 50 | Age 60 |
|---|---|---|---|---|
| New Hampshire | $212 | $332 | $464 | $598 |
| California | $291 | $456 | $638 | $822 |
| Texas | $334 | $523 | $732 | $943 |
| Florida | $301 | $472 | $661 | $851 |
| New York | $320 | $502 | $702 | $904 |
| Wyoming | $554 | $867 | $1,214 | $1,563 |
ACA limits age rating to 3:1 ratio (60-year-old pays max 3x what 21-year-old pays).
After Subsidies: What People Actually Pay
Most marketplace enrollees qualify for premium tax credits. Here’s what people typically pay after subsidies:
Average Monthly Premium After Subsidies
| Income Level (% FPL) | Household Income (Single) | Expected Contribution | Avg Premium After Subsidy |
|---|---|---|---|
| 100-150% FPL | $14,580 - $21,870 | 0-4% of income | $0 - $73 |
| 150-200% FPL | $21,870 - $29,160 | 4-6.3% of income | $73 - $153 |
| 200-250% FPL | $29,160 - $36,450 | 6.3-8.1% of income | $153 - $246 |
| 250-300% FPL | $36,450 - $43,740 | 8.1-9.5% of income | $246 - $346 |
| 300-400% FPL | $43,740 - $58,320 | 9.5% of income | $346 - $462 |
FPL = Federal Poverty Level. Income thresholds for 2025.
States with Highest Subsidy Amounts
| State | Avg Monthly Subsidy | % Getting Subsidies |
|---|---|---|
| Wyoming | $623 | 94% |
| Alaska | $598 | 92% |
| West Virginia | $567 | 91% |
| Nebraska | $534 | 89% |
| Vermont | $512 | 88% |
Medicaid Expansion Impact
States that expanded Medicaid under the ACA generally have lower uninsured rates and more marketplace competition:
Expansion vs. Non-Expansion States
| Category | Avg Benchmark Premium | Uninsured Rate | Insurers per County |
|---|---|---|---|
| Expansion States (40) | $456 | 7.2% | 3.4 |
| Non-Expansion States (10) | $612 | 12.8% | 2.1 |
States That Have NOT Expanded Medicaid (as of 2025)
| State | Uninsured Rate | Coverage Gap |
|---|---|---|
| Texas | 16.6% | 771,000 |
| Florida | 12.7% | 408,000 |
| Georgia | 13.4% | 267,000 |
| Tennessee | 10.1% | 134,000 |
| Alabama | 9.8% | 91,000 |
| Mississippi | 11.2% | 86,000 |
| South Carolina | 10.8% | 83,000 |
| Kansas | 9.4% | 65,000 |
| Wisconsin* | 5.4% | 0 |
| Wyoming | 11.3% | 19,000 |
Wisconsin covers adults up to 100% FPL without full expansion.
Employer-Sponsored Health Insurance by State
Most Americans get health insurance through employers. Costs vary by region:
Annual Employer Plan Premiums (Family Coverage)
| State | Total Premium | Employee Share | Employer Share |
|---|---|---|---|
| Lowest Cost States | |||
| Utah | $19,234 | $5,189 | $14,045 |
| Idaho | $19,567 | $5,423 | $14,144 |
| Arizona | $19,812 | $5,567 | $14,245 |
| Nevada | $20,134 | $5,634 | $14,500 |
| Colorado | $20,456 | $5,723 | $14,733 |
| National Average | $23,968 | $6,575 | $17,393 |
| Highest Cost States | |||
| Alaska | $29,456 | $7,823 | $21,633 |
| New York | $27,834 | $7,456 | $20,378 |
| New Jersey | $27,123 | $7,234 | $19,889 |
| Massachusetts | $26,789 | $7,123 | $19,666 |
| Connecticut | $26,456 | $6,989 | $19,467 |
What Drives Health Insurance Costs by State?
1. Healthcare Provider Costs
| Factor | High-Cost States | Low-Cost States |
|---|---|---|
| Hospital costs | NY, CA, MA | UT, ID, AR |
| Physician wages | Northeast, West Coast | South, Midwest |
| Cost of living | Urban areas | Rural areas |
2. Market Competition
| Insurers per County | Example States | Premium Impact |
|---|---|---|
| 5+ insurers | CA, FL, TX, PA | -15% to -25% |
| 3-4 insurers | Most states | Baseline |
| 1-2 insurers | WY, AK, AL rural | +20% to +40% |
3. State Regulations
| Regulation Type | States | Impact |
|---|---|---|
| State-based marketplace | CA, NY, MA, CO, etc. | Generally lower admin costs |
| Federal marketplace | TX, FL, GA, etc. | Standard federal platform |
| Rate review strict | NY, WA, OR | Limits premium increases |
| Surprise billing protections | All (federal), some stronger | Reduces hidden costs |
4. Population Health
| Health Factor | Higher-Cost States | Lower-Cost States |
|---|---|---|
| Obesity rate | MS, WV, LA | CO, MA, CA |
| Smoking rate | WV, KY, AR | UT, CA, CT |
| Chronic disease | South, Appalachia | West, Northeast |
| Age of population | FL, ME, WV | UT, AK, TX |
Metal Tier Comparison by State
Average Monthly Premiums by Plan Type (40-Year-Old)
| State | Bronze | Silver | Gold | Platinum |
|---|---|---|---|---|
| New Hampshire | $245 | $332 | $398 | $456 |
| California | $334 | $456 | $547 | $638 |
| Texas | $384 | $523 | $628 | $733 |
| Florida | $347 | $472 | $566 | $661 |
| Wyoming | $637 | $867 | $1,040 | $1,214 |
Metal tier quick guide:
- Bronze: Lowest premiums, highest out-of-pocket (60% coverage)
- Silver: Moderate premiums, subsidy-eligible for cost-sharing (70% coverage)
- Gold: Higher premiums, lower deductibles (80% coverage)
- Platinum: Highest premiums, lowest out-of-pocket (90% coverage)
Short-Term Health Insurance by State
Short-term plans are cheaper but offer limited coverage. Availability varies:
Short-Term Plan Regulations by State
| Regulation Level | States | Max Duration |
|---|---|---|
| Banned | CA, MA, NJ, NY, VT, DC | Not available |
| Limited (3-6 months) | CO, MD, NM, WA, OR | 3-6 months |
| Federal rules (12 months) | Most states | 12 months, 36 renewable |
| Unrestricted | TX, FL, GA, TN, AZ | Varies by insurer |
Average short-term premium: $150-250/month (40-year-old) Caveat: Pre-existing conditions not covered, limited benefits
How to Save on Health Insurance
1. Check Subsidy Eligibility
Use healthcare.gov or your state marketplace to see if you qualify. Income limits are generous through 2025.
2. Compare All Metal Tiers
Don’t assume Bronze is cheapest overall—if you use healthcare regularly, Gold may cost less after deductibles.
3. Choose In-Network Providers
Out-of-network care can double or triple your costs. Verify provider networks before enrolling.
4. Use HSA-Eligible Plans
If you’re healthy, a Bronze HDHP with HSA allows tax-free savings for future medical expenses.
5. Consider State Programs
| Program | Eligibility | States |
|---|---|---|
| Medicaid expansion | Up to 138% FPL | 40 states + DC |
| Basic Health Program | 138-200% FPL | NY, MN |
| State subsidies | Various | CA, CO, MA, NJ, VT |
Self-Employed and Gig Worker Options
If you’re self-employed, a freelancer, or gig worker, your options include:
| Option | Best For | Typical Cost |
|---|---|---|
| ACA Marketplace | Most self-employed | Varies by income (subsidies available) |
| Health Sharing Ministry | Religious, healthy individuals | $200-500/month |
| Short-term plan | Temporary gap coverage | $150-250/month |
| Spouse’s employer plan | Married individuals | Employee share only |
| COBRA | Recently left employer | Full premium + 2% admin |
| Professional association | Some professions | Varies |
Tax benefit: Self-employed can deduct 100% of health insurance premiums.
State-by-State Open Enrollment Dates
Most states follow the federal marketplace schedule, but some state-based marketplaces have different dates:
| Marketplace | Open Enrollment Period |
|---|---|
| Federal (HealthCare.gov) | Nov 1 - Jan 15 |
| California | Nov 1 - Jan 31 |
| New York | Nov 1 - Jan 31 |
| Massachusetts | Nov 1 - Jan 23 |
| DC | Nov 1 - Jan 31 |
| Colorado | Nov 1 - Jan 15 |
Special Enrollment: You can enroll outside open enrollment if you have a qualifying life event (job loss, marriage, move, birth of child, etc.).
Conclusion
Health insurance costs vary dramatically by state, with differences exceeding 150% between the cheapest and most expensive markets. Key factors include:
- Competition: More insurers = lower premiums
- Medicaid expansion: Expansion states have lower uninsured rates
- Healthcare costs: Provider prices vary significantly by region
- Subsidies: Most marketplace enrollees pay far less than list price
Action steps:
- Check your subsidy eligibility at healthcare.gov
- Compare plans during open enrollment (Nov 1 - Jan 15)
- Review provider networks before choosing a plan
- Consider HSA-eligible plans for tax savings
Premiums shown are averages for illustrative purposes. Your actual costs depend on age, location, tobacco use, household size, and income. Visit healthcare.gov or your state marketplace for personalized quotes.
Tools
- Coverage Quiz - Find the right insurance types for your situation
Related Guides
- Health Insurance Guide - Complete health coverage overview
- Find Your State Insurance Guide - State-specific insurance information
- HMO vs PPO Guide - Compare health plan types
Data Sources
Cost data in this guide comes from CMS (Centers for Medicare & Medicaid Services) marketplace filings and state insurance department reports. Learn more about our data collection and calculation methods on our Methodology page.
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