Cheapest States for Health Insurance 2026

Health insurance premiums on the ACA Marketplace vary by a factor of 3-4x between the cheapest and most expensive states. A 40-year-old pays around $350/month for a benchmark Silver plan in New Hampshire and over $1,100/month for the same plan in Wyoming. Understanding where your state falls -- and how subsidies change the picture -- is essential for smart plan shopping.

Benchmark Silver Premiums Before Subsidies

The benchmark Silver plan is the second-lowest-cost Silver plan in your area. It's used to calculate your Premium Tax Credit subsidy. These are 2026 estimates for a 40-year-old non-smoker:

10 Cheapest States (Benchmark Silver, Age 40)

10 Most Expensive States (Benchmark Silver, Age 40)

Important: Wyoming is over 3x more expensive than New Hampshire before subsidies. Rural states with limited insurer competition dominate the expensive end of the spectrum.

The Picture After Subsidies

Subsidies flip the script. Your Premium Tax Credit is designed to cap your benchmark Silver premium at a fixed percentage of your income -- regardless of what the actual premium is. In expensive states with high benchmark premiums, subsidies are larger. This means low-to-moderate income households in expensive states often pay similar net premiums to those in cheap states.

Note: Example: A family of 3 earning $60,000 in Wyoming gets a much larger subsidy than the same family in New Hampshire -- because Wyoming's premium is much higher. Their net out-of-pocket cost may be nearly identical. The subsidy absorbs the state's expensiveness.

Net premium example: Single adult, age 40, $45,000 income

At $45,000 income (about 310% FPL), the income cap percentage is roughly 8.5% -- meaning this person pays no more than $318/month (8.5% x $45,000 / 12) regardless of state. The subsidy covers the rest.

Why Health Insurance Costs Vary by State

Number of insurers in the market

States with more insurers competing have lower premiums. Wyoming, Alaska, and West Virginia frequently have only 1-2 insurers offering ACA plans in many counties, eliminating competitive pressure to lower prices.

Medicaid expansion

States that expanded Medicaid (38 states + DC) have lower-risk ACA pools because lower-income and sicker individuals qualify for Medicaid instead of Marketplace plans. Non-expansion states (primarily in the South) have higher-risk, higher-cost ACA pools.

Healthcare provider costs

Hospital and physician costs vary enormously by region. States with high healthcare prices (the Northeast, West Coast) have correspondingly higher insurance premiums. Rural states have fewer providers and less price competition among hospitals.

Population health

States with older, sicker insured populations have higher claim rates and higher premiums. West Virginia, which has high rates of obesity, diabetes, and opioid addiction, consistently has among the highest health insurance premiums in the country.

State-run vs. federal exchange

States that run their own exchanges (California, New York, Massachusetts, Washington, Colorado, and others) often have stronger competition, better consumer tools, and sometimes lower premiums than states using the federal Healthcare.gov exchange.

How to Find the Lowest Net Premium in Any State

1. Check all plans, not just Silver -- your subsidy applies to any metal tier. If you qualify for CSR subsidies (100-250% FPL), Silver is usually best. Otherwise, applying your subsidy to a Bronze plan can result in a $0 or very low monthly premium.
2. Compare at the county level, not state level -- premiums vary by county within states. A rural county with one insurer may be 40% more expensive than a suburban county in the same state.
3. Reduce your MAGI to increase your subsidy -- HSA contributions, traditional IRA contributions, and self-employed health insurance deductions all reduce your Modified Adjusted Gross Income, which increases your subsidy eligibility.
4. Shop during Open Enrollment, not just at the deadline -- new plans enter markets and pricing changes year to year. Your cheapest plan last year may not be cheapest this year.
5. Check Medicaid eligibility -- if your income is below 138% FPL in a Medicaid expansion state, you qualify for free Medicaid coverage. This beats any Marketplace plan on cost.

Worked Example: Same Income, Different States

A 40-year-old earning $38,000/year (roughly 235% of the federal poverty level for a single person) will see very different net premiums depending on which state they live in, even though the subsidy formula itself is federal:

This is the detail that surprises a lot of people comparing states: because the subsidy is calculated as the gap between the benchmark premium and your expected contribution, your actual out-of-pocket net premium can end up nearly identical in a cheap state and an expensive one, as long as your income and household size are the same. The state-level cost difference mostly shows up in what happens if you earn too much to qualify for a subsidy, or if you choose a plan above the benchmark tier -- that's when the underlying gross premium differences actually hit your wallet directly.

Medicaid Expansion Status Matters More Than the Sticker Price

States that expanded Medicaid under the ACA extend free or near-free coverage to adults earning up to 138% of the federal poverty level. In non-expansion states, adults below the poverty line who don't qualify for traditional Medicaid can fall into a coverage gap -- earning too little to qualify for ACA marketplace subsidies (which start at 100% FPL) but too much for their state's more restrictive Medicaid program. This gap affects hundreds of thousands of people in non-expansion states and has nothing to do with a state's benchmark premium -- it's a purely structural difference in program eligibility.

Before assuming marketplace shopping is your only option, check your state's specific Medicaid expansion status and income thresholds at healthcare.gov, which screens marketplace applications for Medicaid eligibility automatically and routes qualifying applicants to the correct program.

How Age Affects State Rankings

Age rating rules are federal, but their dollar impact varies by state because it's applied on top of a different local benchmark premium in each market -- meaning the absolute size of the age-related increase differs even though the percentage rules are the same everywhere.

The state rankings above are for a 40-year-old. Older applicants (age 60+) pay up to 3x more than 21-year-olds -- but the relative state rankings stay roughly the same. The cheapest states for a 40-year-old are generally also the cheapest for a 60-year-old.

Younger people have more options to consider: ACA Catastrophic plans are available for those under 30 and combine low premiums with ACA consumer protections. These are worth comparing against Bronze plans if you're young and healthy.

If you're relocating for work or considering a move for cost-of-living reasons, it's worth running your specific income and household size through your destination state's marketplace before finalizing the decision, since the interaction between local benchmark premiums, your subsidy amount, and your state's Medicaid expansion status can meaningfully change your total healthcare budget in ways a simple cost-of-living comparison won't capture. A move that looks favorable on rent and groceries alone can look very different once healthcare costs are factored in accurately.