Quick answer
Every insurer selling ACA-compliant plans prices them using the same five factors: age, location, tobacco use, family size and plan level. What differs is each company’s base rate. That depends on its network and the prices it has negotiated with hospitals and doctors, its plan designs, how healthy its members are, and its administrative costs and business goals. So the same person can get very different quotes for similar plans.
Key takeaways
- Insurers can’t use your health to set ACA premiums, so price gaps come from the companies, not from you.
- Networks and negotiated prices are the biggest reason one insurer costs more than another.
- Plans at the same metal level can have different deductibles, copays and drug lists.
- Insurers set their own tobacco surcharge, up to 50%, so smokers may see bigger gaps.
- Premium tax credits are based on the second-lowest-cost silver plan, so choosing a cheaper plan saves you the full difference.
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Why quotes differ between insurers
All insurers use the same rating factors, explained in how health insurance rates are determined. The differences come from the companies themselves:
- Networks. A plan built around a lower-cost hospital system or a narrow network usually costs less than one with a broad network or a famous academic medical center.
- Negotiated prices. Big insurers or insurers owned by health systems may pay very different rates for the same care.
- Plan design. Two silver plans can have different deductibles, copays, coinsurance and drug lists.
- Plan type. HMOs and EPOs usually cost less than PPOs.
- Who they insure. An insurer whose members use more care will set higher rates.
- Costs and strategy. Administrative costs, profit targets and how hard a company is trying to win customers in a market all play a part. States review rate filings, and insurers have to spend at least 80% of premiums on care and quality or pay rebates.
Tobacco and other factors
Insurers decide how large a tobacco surcharge to charge, up to 50%, and some states ban or limit it. If you use tobacco, quotes can differ more than usual. See does smoking affect your health insurance rates. Things like riding a motorcycle or your job can’t affect an ACA premium.
How to use price differences to your advantage
- Compare every insurer in your area. Don’t assume the biggest name is the best deal. See the best health insurance companies.
- Compare after the tax credit. Your credit is based on the benchmark silver plan. If you pick a plan that costs less than the benchmark, you keep the whole difference.
- Check the network before the price. A cheaper plan that leaves out your doctors can cost more in the end. See how to find out if a doctor is covered by your insurance.
- Look at the full-year cost: premiums plus the deductible and out-of-pocket maximum. Considerations when comparing health insurance rates walks through it.
- Re-shop every year. Prices and insurers change. For 2027, insurers proposed increases from -1% to 54%, with a median of 15%.
See quotes from the insurers in your area side by side: compare plans by ZIP code.
Frequently asked questions
Why is the same kind of plan so much cheaper with one company?
Usually because of its network and the prices it pays hospitals and doctors. Check that the cheaper plan includes the doctors and hospitals you want.
Do insurers use my health history to set my price?
Not for ACA-compliant plans. Short-term plans and other non-ACA coverage can.
Is the cheapest insurer a bad insurer?
Not necessarily. Check its network, drug list and quality ratings before you decide.
Sources
This article is general information, not insurance advice. Prices and insurers vary by area. Last reviewed September 2026.