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.
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.
2. South Dakota
Monthly cost: $811
Annual cost: $9,732
Difference from national average: +50.02%
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3. Wyoming
Monthly cost: $764
Annual cost: $9,168
Difference from national average: +41.32%
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4. Vermont
Monthly cost: $760
Annual cost: $9,120
Difference from national average: +40.58%
5. Louisiana
Monthly cost: $728
Annual cost: $8,736
Difference from national average: +34.67%
6. Alaska
Monthly cost: $715
Annual cost: $8,580
Difference from national average: +32.26%
7. New York
Monthly cost: $713
Annual cost: $8,556
Difference from national average: +31.89%
8. Nebraska
Monthly cost: $685
Annual cost: $8,220
Difference from national average: +26.71%
9. Oklahoma
Monthly cost: $635
Annual cost: $7,620
Difference from national average: +17.46%
10. North Carolina
Monthly cost: $634
Annual cost: $7,608
Difference from national average: +17.28%
11. Missouri
Monthly cost: $620
Annual cost: $7,440
Difference from national average: +14.69%
12. Florida
Monthly cost: $585
Annual cost: $7,020
Difference from national average: +8.21%
13. Alabama
Monthly cost: $579
Annual cost: $6,948
Difference from national average: +7.1%
14. Nevada
Monthly cost: $578
Annual cost: $6,936
Difference from national average: +6.92%
15. Arizona
Monthly cost: $577
Annual cost: $6,924
Difference from national average: +6.73%
16. Texas
Monthly cost: $575
Annual cost: $6,900
Difference from national average: +6.36%
17. Connecticut
Monthly cost: $564
Annual cost: $6,768
Difference from national average: +4.33%
18. Utah
Monthly cost: $563
Annual cost: $6,756
Difference from national average: +4.14%
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19. Illinois
Monthly cost: $556
Annual cost: $6,672
Difference from national average: +2.85%
20. Delaware
Monthly cost: $555
Annual cost: $6,660
Difference from national average: +2.66%
21. California
Monthly cost: $537
Annual cost: $6,444
Difference from national average: -0.67%
21. New Jersey
Monthly cost: $537
Annual cost: $6,444
Difference from national average: -0.67%
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23. Massachusetts
Monthly cost: $535
Annual cost: $6,420
Difference from national average: -1.04%
24. Kansas
Monthly cost: $534
Annual cost: $6,408
Difference from national average: -1.22%
25. Iowa
Monthly cost: $533
Annual cost: $6,396
Difference from national average: -1.41%
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26. North Dakota
Monthly cost: $524
Annual cost: $6,288
Difference from national average: -3.07%
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27. Idaho
Monthly cost: $516
Annual cost: $6,192
Difference from national average: -4.55%
28. Wisconsin
Monthly cost: $514
Annual cost: $6,168
Difference from national average: -4.92%
29. Virginia
Monthly cost: $512
Annual cost: $6,144
Difference from national average: -5.29%
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30. Mississippi
Monthly cost: $511
Annual cost: $6,132
Difference from national average: -5.48%
31. Tennessee
Monthly cost: $508
Annual cost: $6,096
Difference from national average: -6.03%
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32. Pennsylvania
Monthly cost: $498
Annual cost: $5,976
Difference from national average: -7.88%
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33. Hawaii
Monthly cost: $490
Annual cost: $5,880
Difference from national average: -9.36%
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