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Health Insurance

The States With the Cheapest and Most Expensive Health Insurance

July 31, 20224 min read Angie K. Claar

Enrollment in the federal health insurance marketplace reached a record high this year. The increase was likely due to increased premium tax credits for the coverage and extended eligibility that was part of the American Rescue Plan signed by President Joe Biden in 2021, according to the Urban Institute.

But the tax credits are due to expire at the end of this year. The Urban Institute says that if the enhancements are not extended, 3.1 million more people will be uninsured in 2023, and enrollees who remain will spend hundreds of dollars more per person on premiums.

And premiums are just the start. Many U.S. households do not have enough money available to cover the cost of a typical deductible in a private health plan, according to an analysis by the Kaiser Family Foundation. About a third of single-person households with private insurance in 2019 could not pay a $2,000 bill, and half could not pay a $6,000 bill, according to KFF.

And that leads to medical debt. Nearly 1 in 10 adults – or roughly 23 million people – owe medical debt, according to KFF. This includes 11 million who owe more than $2,000 and 3 million people who owe more than $10,000.

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The costs are eating up Americans’ paychecks. Premium contributions and deductibles totaled 11.6% of median income in 2020, up from 9.1% in 2010, according the Commonwealth Fund.

Americans spend more on health care than any other nation by far—$12,318 per capita, according to the OECD; that’s $4,935 more than the next most expensive country, Germany, which spends $7,383 per capita.

Health care affordability isn’t just an issue for those who pay healthcare on their own or through the marketplace, it’s becoming a burden even to large employers who provide the benefit to their workers. A 2021 survey by Kaiser Family Foundation found that overall, large employers find healthcare costs excessive and that that the cost of providing health benefits to employees will become unsustainable in the next five to 10 years. Some 85% of respondents believe that there will need to be greater government roles in providing coverage and containing costs. One respondent noted in a follow-up interview, “if it’s not the government stepping in, who would it be?”

This list shows the average cost of health insurance in each of the 50 states, ranging from $831 a month in West Virginia, the most expensive state, to $309 a month in the cheapest state.

The figures come from Value Penguin, which aggregated premium rates from the Centers for Medicare & Medicaid Services site. Using the rates and premiums for each plan, averages were calculated for a variety of variables such as metal tier, family size or county. Average costs per state are calculated from a silver plan for 40-year-old.

17 charleston WV sh

1. West Virginia

  • Monthly cost: $831
  • Annual cost: $9,972
  • Difference from national average: +53.72%

A number of factors contribute to the reason some states cost more than others. One of them is called “silver loading,” where insurers raise the premiums they charge for silver plans to offset the now-uncompensated cost of providing cost-sharing reductions. You can read more about silver loading at Brookings. 

West Virginia is one of three states that doesn’t allow silver loading, and this is one of the reasons premiums are high here, as explained by the West Virginia Center on Budget and Policy. They also show how much more West Virginians will pay if the American Rescue Plan tax credits are allowed to expire at the end of the year.

sdakota rushmore sh

2. South Dakota

  • Monthly cost: $811
  • Annual cost: $9,732
  • Difference from national average: +50.02%
20 casper wyoming Andrew Farkas:Wikipedia

Andrew Farkas/Wikipedia

3. Wyoming

  • Monthly cost: $764
  • Annual cost: $9,168
  • Difference from national average: +41.32%
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Shutterstock

4. Vermont

  • Monthly cost: $760
  • Annual cost: $9,120
  • Difference from national average: +40.58%
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5. Louisiana

  • Monthly cost: $728
  • Annual cost: $8,736
  • Difference from national average: +34.67%
34 alaska skagway  Paolo Trovo : Shutterstock.

6. Alaska

  • Monthly cost: $715
  • Annual cost: $8,580
  • Difference from national average: +32.26%
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7. New York

  • Monthly cost: $713
  • Annual cost: $8,556
  • Difference from national average: +31.89%
nebraska fishing sh

8. Nebraska

  • Monthly cost: $685
  • Annual cost: $8,220
  • Difference from national average: +26.71%
19 Oklahoma City dog bike sh

9. Oklahoma

  • Monthly cost: $635
  • Annual cost: $7,620
  • Difference from national average: +17.46%
19 asheville Ncarolina sh

10. North Carolina

  • Monthly cost: $634
  • Annual cost: $7,608
  • Difference from national average: +17.28%
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11. Missouri

  • Monthly cost: $620
  • Annual cost: $7,440
  • Difference from national average: +14.69%
3 West palm beach florida GagliardiImages : Shutterstock

12. Florida

  • Monthly cost: $585
  • Annual cost: $7,020
  • Difference from national average: +8.21%
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13. Alabama

  • Monthly cost: $579
  • Annual cost: $6,948
  • Difference from national average: +7.1%
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14. Nevada

  • Monthly cost: $578
  • Annual cost: $6,936
  • Difference from national average: +6.92%
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15. Arizona

  • Monthly cost: $577
  • Annual cost: $6,924
  • Difference from national average: +6.73%
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16. Texas

  • Monthly cost: $575
  • Annual cost: $6,900
  • Difference from national average: +6.36%
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17. Connecticut

  • Monthly cost: $564
  • Annual cost: $6,768
  • Difference from national average: +4.33%
salt lake utah sh

18. Utah

  • Monthly cost: $563
  • Annual cost: $6,756
  • Difference from national average: +4.14%
29 illinois springfield Brian S : Shutterstock.

Shutterstock

19. Illinois

  • Monthly cost: $556
  • Annual cost: $6,672
  • Difference from national average: +2.85%
4 Rehoboth Beach, Delaware

20. Delaware

  • Monthly cost: $555
  • Annual cost: $6,660
  • Difference from national average: +2.66%
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21. California

  • Monthly cost: $537
  • Annual cost: $6,444
  • Difference from national average: -0.67%
1 new jersey Manasquan Inlet Beach sh

21. New Jersey

  • Monthly cost: $537
  • Annual cost: $6,444
  • Difference from national average: -0.67%
boston mass sean pavone shutterstock

Sean Pavone/Shutterstock

23. Massachusetts

  • Monthly cost: $535
  • Annual cost: $6,420
  • Difference from national average: -1.04%
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24. Kansas

  • Monthly cost: $534
  • Annual cost: $6,408
  • Difference from national average: -1.22%
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25. Iowa

  • Monthly cost: $533
  • Annual cost: $6,396
  • Difference from national average: -1.41%
16 univ Ndakota grand forks Ken Wolter : Shutterstock

Ken Wolter / Shutterstock

26. North Dakota

  • Monthly cost: $524
  • Annual cost: $6,288
  • Difference from national average: -3.07%
22 boise idaho Checubus : Shutterstock

Checubus / Shutterstock

27. Idaho

  • Monthly cost: $516
  • Annual cost: $6,192
  • Difference from national average: -4.55%
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28. Wisconsin

  • Monthly cost: $514
  • Annual cost: $6,168
  • Difference from national average: -4.92%
27. Richmond, Virginia sh

29. Virginia

  • Monthly cost: $512
  • Annual cost: $6,144
  • Difference from national average: -5.29%
gulfport, mississippi

Shutterstock

30. Mississippi

  • Monthly cost: $511
  • Annual cost: $6,132
  • Difference from national average: -5.48%
chattanooga tenn sh

31. Tennessee

  • Monthly cost: $508
  • Annual cost: $6,096
  • Difference from national average: -6.03%
  • 23 Philadelphia sh

    Shutterstock

    32. Pennsylvania

    • Monthly cost: $498
    • Annual cost: $5,976
    • Difference from national average: -7.88%
    3 hawaii hanalei sh

    Shutterstock

    33. Hawaii

    • Monthly cost: $490
    • Annual cost: $5,880
    • Difference from national average: -9.36%
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    aceshot1 / Shutterstock

    33. Ohio

    • Monthly cost: $490
    • Annual cost: $5,880
    • Difference from national average: -9.36%
    6 albuquerque new mexico Raisa Nastukova : Shutterstock

    Raisa Nastukova / Shutterstock

    35. New Mexico

    • Monthly cost: $480
    • Annual cost: $5,760
    • Difference from national average: -11.21%
    42 montana livingston Nick Fox : Shutterstock

    36. Montana

    • Monthly cost: $479
    • Annual cost: $5,748
    • Difference from national average: -11.39%
    12 frankfort kentucky sh

    37. Kentucky

    • Monthly cost: $478
    • Annual cost: $5,736
    • Difference from national average: -11.58%
    21 portland oregon sh

    38. Oregon

    • Monthly cost: $475
    • Annual cost: $5,700
    • Difference from national average: -12.13%
    18 portland maine sh

    Shutterstock

    39. Maine

    • Monthly cost: $465
    • Annual cost: $5,580
    • Difference from national average: -13.98%
    seattle, washington, mt rainier

    Shutterstock

    40. Washington

    • Monthly cost: $443
    • Annual cost: $5,316
    • Difference from national average: -18.05%
    charleston, south carolina

    Shutterstock

    41. South Carolina

    • Monthly cost: $436
    • Annual cost: $5,232
    • Difference from national average: -19.35%
    23 indiana bloomington univ sh

    Shutterstock

    42. Indiana

    • Monthly cost: $433
    • Annual cost: $5,196
    • Difference from national average: -19.90%
    9 bentonville arkansas RozenskiP : Shutterstock

    RozenskiP / Shutterstock

    43. Arkansas

    • Monthly cost: $419
    • Annual cost: $5,028
    • Difference from national average: -22.49%
    7 newport RI rhode island sh

    44. Rhode Island

    • Monthly cost: $413
    • Annual cost: $4,956
    • Difference from national average: -23.60%
    ann arbor mich Paul Brady Photography : Shutterstock.

    45. Michigan

    • Monthly cost: $410
    • Annual cost: $4,920
    • Difference from national average: -24.16%
    13. Idaho Springs, Colorado sh

    46. Colorado

    • Monthly cost: $409
    • Annual cost: $4,908
    • Difference from national average: -24.34%
    8 rochester minn Ken Wolter : Shutterstock

    Ken Wolter / Shutterstock

    47. Minnesota

    • Monthly cost: $389
    • Annual cost: $4,668
    • Difference from national average: -28.04%
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    Shutterstock

    48. Maryland

    • Monthly cost: $365
    • Annual cost: $4,380
    • Difference from national average: -32.48%
    new hampshire portsmouth sh

    49. New Hampshire

    • Monthly cost: $360
    • Annual cost: $4,320
    • Difference from national average: -33.41%
    13 Savannah Georgia sh

    Shutterstock

    50. Georgia

    • Monthly cost: $309
    • Annual cost: $3,708
    • Difference from national average: -42.84%

    See this list at ValuePenguin.com.

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