Quick answer
Health care spending varies a lot from place to place. In the Health Care Cost Institute’s study of 183 metro areas, spending per person with employer insurance in 2021 ranged from just under $3,500 in Bakersfield, California, to just over $11,000 in Charleston, West Virginia. Differences come from both how much care people use and what it costs. Insurance premiums vary too: in 2026 the benchmark marketplace plan for a 40-year-old ranged from $401 a month in New Hampshire to $1,299 in Vermont.
Key takeaways
- Per-person spending in the highest-spending metro was about three times that of the lowest in 2021.
- Prices in the most expensive metro were more than double those in the cheapest.
- Two-thirds of the metros studied had highly concentrated hospital markets, which tends to push prices up.
- Marketplace premiums depend on your state and county.
- For people who qualify, premium tax credits limit how much high local prices raise what you pay.
On this page
Where marketplace premiums are highest and lowest
| Highest average benchmark premium, 2026 | Monthly | Lowest average benchmark premium, 2026 | Monthly |
|---|---|---|---|
| Vermont | $1,299 | New Hampshire | $401 |
| Wyoming | $1,090 | Maryland | $414 |
| West Virginia | $1,073 | Minnesota | $448 |
| Alaska | $1,032 | Virginia | $455 |
| Connecticut | $870 | Indiana | $474 |
Why health costs vary by place
- Prices. Where one hospital system dominates, it can negotiate higher prices from insurers.
- How much care people use. In HCCI’s data, people in the highest-use metros used nearly three times as much care as those in the lowest.
- Health of the population. Areas with more chronic illness spend more.
- Local wages and costs. Labor and real estate cost more in some regions.
- Insurer competition. Places with only one or two insurers often have higher premiums. In 2026, 165 counties had just one marketplace insurer.
- State policy. Reinsurance programs and state subsidies lower premiums in some states.
What this means for your premium
Insurers set prices by rating area, usually a group of counties, so moving even a short distance can change your premium. Age, tobacco use and plan level matter too; see how health insurance rates are determined. If your household income is between 100% and 400% of the poverty level, a premium tax credit caps what you pay for the benchmark plan as a share of your income, so you’re shielded from much of the local price difference. Above 400%, you pay the full local price.
If you’re moving
Plans and networks are local, so you usually can’t take an individual plan to another state. Moving gives you a special enrollment period to pick a new plan. See can you transfer health insurance to a new state. Compare costs in your new area before you move, especially if you buy your own coverage; see health insurance for individuals.
See what plans cost where you live: compare quotes by ZIP code.
Frequently asked questions
Which state has the most expensive health insurance?
Vermont had the highest average benchmark premium for a 40-year-old in 2026, at $1,299 a month before subsidies.
Which state has the cheapest health insurance?
New Hampshire, at $401 a month for a 40-year-old’s benchmark plan in 2026.
Why is health care so expensive in some small cities?
Often because one hospital system dominates the area, which lets it charge higher prices, and because fewer insurers compete there.
Sources
This article is general information, not insurance advice. Premiums and prices change every year. Last reviewed September 2026.