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The same silver plan, for the same 40-year-old, costs about $394 a month in New Hampshire and about $1,289 a month in Vermont. Those two states share a border. KFF’s analysis of the lowest-cost silver plans for 2026 puts the national average at $611 a month, and almost no state actually sits near it.
Premiums on the marketplace are set locally. Insurers price by rating area, usually a county or a group of counties, and the price reflects what hospitals and doctors charge in that area, how many insurers compete there, and how healthy the local risk pool is. A state average hides all of that, but it still tells you which markets run hot and which run cheap.
The expensive end and the cheap end
According to KFF’s 2026 figures for the lowest-cost silver plan for a 40-year-old, the highest state averages are Vermont at $1,289 a month, Wyoming at $1,089, West Virginia at $1,036, and Alaska at $1,019. The lowest are New Hampshire at $394, Maryland at $403, Minnesota at $437, Virginia at $455, and Indiana at $473. The gap between the top and the bottom is more than three to one.
ValuePenguin’s analysis of 2026 marketplace selections tells the same story from a different angle. Its average premium across all plans and ages, before tax credits, runs from about $509 a month in Idaho to about $1,314 in West Virginia. Rural states with one dominant hospital system and few insurers tend to land at the expensive end. States with several competing insurers and lower provider prices land at the cheap end.
Why your state costs what it costs
Competition is the biggest lever you can see from the outside. Counties with a single insurer have no pressure on price. Provider prices matter just as much: where one hospital system employs most of the doctors, negotiated rates run higher, and premiums follow. State rules play a role too. New York and Vermont use pure community rating, so younger buyers pay more and older buyers pay less than the national pattern, which pushes their averages up for the 40-year-old benchmark. Some states also run reinsurance programs that pay part of the cost of the most expensive claims, and those programs have held premiums down in states that adopted them.
None of this is under your control, which is why the practical question is narrower: given your state’s prices, how do you pay less inside them?
What you can actually do about it
First, check your premium tax credit before you judge your state’s prices. Credits are calculated from the benchmark plan in your own rating area, so a high-premium state also generates a larger credit for households under the income limits. Plenty of people in expensive states pay less out of pocket than people in cheap states who earn too much to qualify. Our breakdown of how much health insurance costs per month shows what people pay after credits at different ages and incomes.
Second, compare every tier in your county instead of anchoring on silver. In some counties a gold plan prices close to silver because of how insurers loaded costs onto silver plans in past years. Third, if you are near a state line and moving is genuinely on the table for other reasons, know that premiums reset when you move, and a move triggers a special enrollment period. Our guide on how marketplace premiums rise with age explains the other half of the pricing formula, the age curve, so you can estimate what a plan will cost you at 50 or 60 in the state you live in now.
If you just moved, read what happens to your health insurance when you move states before your old coverage ends, because the enrollment window after a move is time limited.
