We analyzed benchmark Silver plan premiums in all 50 US states for a 40-year-old non-smoker in 2026. New Hampshire is cheapest at $349/month. West Virginia is most expensive at $830/month — a 138% gap.
Health insurance premiums vary dramatically by state. Three factors drive most of the difference:
| Rank | State | Benchmark Silver / Mo | Carriers | Medicaid Expansion |
|---|---|---|---|---|
| 1 | New Hampshire | $349 | 5+ | |
| 2 | Maryland | $362 | 5+ | |
| 3 | Rhode Island | $368 | 4 | |
| 4 | Massachusetts | $375 | 10+ | |
| 5 | Michigan | $385 | 8+ | |
| 6 | Pennsylvania | $392 | 11+ | |
| 7 | New Mexico | $395 | 4 | |
| 8 | Utah | $398 | 4 | |
| 9 | Nevada | $402 | 5 | |
| 10 | Arizona | $405 | 6 |
| Rank | State | Benchmark Silver / Mo | Carriers | Medicaid Expansion |
|---|---|---|---|---|
| 50 | West Virginia | $830 | 1–2 | |
| 49 | Wyoming | $782 | 1 | |
| 48 | Vermont | $745 | 2 | |
| 47 | Alaska | $715 | 2 | |
| 46 | Louisiana | $648 | 4 | |
| 45 | Mississippi | $612 | 3 | |
| 44 | South Dakota | $595 | 3 | |
| 43 | Oklahoma | $578 | 4 | |
| 42 | Nebraska | $565 | 3 | |
| 41 | Tennessee | $542 | 4 |
The pre-subsidy rankings tell you the cost of raw insurance in each state. But most Americans don't pay anywhere close to those numbers. ACA premium tax credits cap your premium as a percentage of income — meaning a person earning $30,000 pays the same out-of-pocket whether they live in cheap New Hampshire or expensive West Virginia.
What subsidies actually do: shift more federal money to high-cost states. Residents pay similar amounts; the federal government picks up more of the tab in expensive states.
The "cheapest" state on raw price (New Hampshire) isn't necessarily where you'll pay the least. Three states stand out as most affordable for low-income enrollees due to enhanced state-level subsidies on top of federal:
Benchmark Silver plan premiums were collected from CMS marketplace data and HealthCare.gov for a 40-year-old non-smoker shopping in the most populous ZIP code of each state. Carrier counts reflect on-marketplace participating issuers. Medicaid expansion status reflects current state law as of April 2026.
Source: TrustedQuotes 2026 Health Insurance Cost Study (https://www.trustedquotes.org/cheapest-states-health-insurance)
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