Where health insurance costs the most in 2026

Browse Health Plans team · Reviewed by a licensed health insurance advisor · Updated October 26, 2026

The most expensive place in the HealthCare.gov states to buy a Marketplace plan at full price in 2026 is Monroe County, Florida, the Florida Keys, where a 40-year-old pays $949 a month for the lowest-priced Bronze plan and a single insurer sells every one of the 33 plans on offer. Cabell, Putnam, Mason and Wayne counties in West Virginia, around Huntington, come next at $848, then the rest of the Parkersburg area of West Virginia at $835, and 21 of Wyoming's 23 counties at $795. Apache County, Arizona is $781, Yuma County, Arizona is $772 and the Alaska boroughs outside Anchorage are $681 to $729. The median county across the 2,055 counties in the federal file is $482, so the top of the list is roughly double the typical county.

Every figure here is the full monthly premium, before any tax credit, for one 40-year-old non-smoker, from the official 2026 plan file (CMS QHP Landscape PY2026, snapshot August 4, 2026). We ranked every county by its lowest-priced Bronze plan at that age, the same figure shown on each county page of this site; how we price explains the method. The 20 states and the District of Columbia that run their own marketplaces are not in the federal file and are not ranked. This is the companion to our ranking of the cheapest counties, and it ends the same way: with the tax credit turning the ranking on its head.

The 25 most expensive counties with 50,000 or more residents

Every row links to that county's prices, either its own page or the tool with its ZIP code filled in. The deductible belongs to the cheapest Bronze plan itself, and the last two columns show how thin these markets are.

One adult, 40, non-tobacco, full monthly premium of the lowest-priced Bronze plan sold in the county, from the CMS plan-year 2026 Individual Medical file (snapshot August 4, 2026). Counties under 50,000 residents are excluded; the smaller Hamilton County, Florida prices at $933 with two insurers, and the 21 small Wyoming counties in the state's main rating area all price at $795.

West Virginia fills 11 of the 25 rows, Arizona and Alaska fill nine between them, and Wyoming and Utah take the rest. Florida's one entry sits alone at the top, and it is a special case: Monroe County is an island chain with its own rating area and a single insurer that chose to sell there. Miami-Dade, the next county up the road, has 11 insurers and a cheapest Bronze of $502. With no competing filing, there is nothing in the Keys pushing the price down.

The deductible column is the second surprise: expensive counties do not buy better plans. The $848 Bronze in Cabell County carries a $9,200 deductible that doubles as the out-of-pocket maximum. Natrona and Laramie counties in Wyoming pair a $740 to $773 premium with the $10,600 legal maximum deductible, so a 40-year-old there pays about $9,000 a year in premiums for a plan that then asks for another $10,600 before it covers a hospital stay.

The most expensive county in every HealthCare.gov state

The highest county in a state shows where the ceiling is, and the gap between it and the median county shows how uneven the state is. Some states are expensive everywhere; others are cheap in the cities and expensive in one rural corner.

Cheapest Bronze plan for one 40-year-old, full price, CMS plan-year 2026 file (snapshot August 4, 2026). Medians are across counties, not weighted by population. Where many counties tie for the highest price, the count or a few names are given.

Three states are expensive from border to border. West Virginia's cheapest county, Berkeley, is $682, Wyoming's floor is $740 and Alaska's is $648, so a 40-year-old paying full price in those states has no cheaper county to move to. Florida, Arizona, Kansas and Wisconsin are the opposite: most residents live in counties priced near or below the national median, and the state's top price belongs to one rural or isolated county that few people live in. Our guides to prices at 40 in every state and Texas versus Florida go deeper on the big states.

Why these counties cost so much: the one-insurer pattern

The clearest explanation in the plan file is how many insurers chose to sell in each county. Across all 2,055 counties, the 57 with a single insurer have a median cheapest Bronze of $723 for a 40-year-old. Counties with two insurers have a median of $581, counties with three sit at $475, and counties with six or more are at $423. Of the 100 most expensive counties, 29 have one insurer and 69 have two; only two have three or more. The relationship is not perfect, because Delaware's three insurers still price a 40-year-old at $542 everywhere, but it is the strongest single pattern in the data.

The single-insurer counties cluster in Alaska (17 of its 30 boroughs and census areas), Kansas (14 counties), Alabama and Texas (7 each) and Oklahoma (5), and together hold about one million residents. West Virginia and Wyoming are two-insurer states where the same two companies compete statewide and neither has filed a low Bronze plan the way insurers have in Iowa, Michigan or New Hampshire. Behind the insurer count typically sit the usual drivers of medical cost: a single hospital with little price competition, older risk pools, and distances that make narrow-network HMOs impractical. Most of the expensive-county plans in the table are PPOs or EPOs, because in a county with one hospital there is no network to narrow; our guide to network types explains why that matters for the price.

The flip side: a high price means a large tax credit

The premium tax credit is the difference between the second-lowest Silver plan in your county, the benchmark, and a fixed share of your income. In expensive counties the benchmark is enormous, so the credit is too. Here is the same single 40-year-old at three incomes in the most expensive counties, next to Houston and the cheapest county in New Hampshire:

Cheapest Bronze after the estimated 2026 premium tax credit for a single 40-year-old, household of one, 2026 rules (IRS Rev. Proc. 2025-25, HHS 2025 poverty guidelines). In the 48 contiguous states $35,000 is 224% of the poverty level, $50,000 is 319% and $60,000 is 383%; Alaska uses higher guidelines, so $60,000 there is 307%. The Marketplace sets the final credit.

At $50,000 the ranking inverts. The person in Monroe County pays $86 a month for a Bronze plan that lists at $949, because the credit covers $863 of it. The same person in Hillsborough County, New Hampshire, the cheapest county in the country at full price, pays $317, because a $388 benchmark produces no credit at all. In Anchorage, Alaska's higher poverty guidelines keep a $50,000 earner at 256% of the poverty level, where the credit exceeds the cheapest Bronze and the plan is free. At $35,000 the cheapest Bronze is free in every expensive county on the list, and a Silver plan with cost-sharing reductions is usually the better buy for a few dollars more.

Families see the same thing. Two parents aged 40 and 38 with two children face a full-price Bronze of $3,034 a month in Monroe County and $2,525 in Kanawha County. At $85,000 of income, 264% of the poverty level, the estimated credit is $3,456 in Monroe and $2,869 in Kanawha, more than the cheapest Bronze costs, so the family pays nothing for it and can put the surplus toward Silver or Gold. Our guide to how the 2026 premium tax credit works walks through the maths.

Where the price does bite: over the 400% line and at 60

The credit disappears entirely above 400% of the poverty level, which for 2026 is $62,600 for one person, $84,600 for a couple and $128,600 for a family of four in the 48 contiguous states, and higher in Alaska and Hawaii. The enhanced credits that softened that cliff from 2021 through 2025 expired on December 31, 2025. A family of four earning $130,000 in Monroe County pays the full $3,034 a month, about $36,400 a year, for a Bronze plan; in Kanawha County it is $2,525 a month, about $30,300 a year. Our guide to the family-of-four cliff covers what that household can do about it.

Age multiplies everything. Under the federal age curve a 60-year-old pays about 2.1 times what a 40-year-old pays, so the cheapest Bronze at 60 is $2,015 a month in Monroe County, $1,801 in Cabell County, $1,658 in Apache County, $1,641 in Natrona County and $1,376 in Anchorage. Under the line, though, the benchmark at 60 in Monroe County is $2,713, and the credit for a single 60-year-old earning $50,000 is about $2,298, which leaves the cheapest Bronze at zero. Our guide to costs at 60 has the state-by-state figures.

The private alternative in the expensive states

Private plans are priced on age, sex and health rather than county or income, so the Keys and Miami see the same starting range, and Charleston, West Virginia is priced like Martinsburg. For a healthy 40-year-old the starting ranges our advisors typically quote are $200 to $629 a month for a man and $236 to $681 for a woman in Florida, $183 to $608 and $216 to $656 in West Virginia, $181 to $606 and $216 to $656 in Wyoming, and $172 to $595 and $206 to $644 in Arizona. We do not publish a private range online for Alaska yet; an advisor quotes it by phone.

The honest comparison runs both ways. For a healthy household paying full Marketplace price in one of these counties, the private low end is a fraction of the Marketplace floor, often with a lower deductible and a wider network. But private plans are medically underwritten and are not ACA coverage: the application asks health questions, and the carrier can decline you, charge more, or exclude a condition. They do not qualify for the tax credit. Anyone with a tax credit, or with an ongoing condition, usually does better on the Marketplace, which must accept everyone at the standard rate and cannot exclude anything, and in these counties that credit is unusually large. The ranges are starting points for healthy applicants, and nothing here is a promise of what you will pay.

How to use this ranking

• Check the after-credit price before you panic. Under the 400% line, the full-price number for your county tells you almost nothing. Enter your ZIP in the price comparison tool and read the figure after the estimated credit.
• Over the line, compare both markets. Full price is what you pay on the Marketplace, so a private quote is worth a conversation if everyone in the household is healthy. The tool shows both side by side.
• Look at the deductible, not just the ranking. A $790 plan with a $9,200 deductible is a catastrophic plan with a large premium. If you expect to use care, compare the cheapest Gold on the county page; in Kanawha County it is $980 for a 40-year-old.
• Know the cliff before you take the raise. Where the benchmark is over $1,000, one dollar of income over the 400% line can cost a family more than $30,000 a year in lost credit. Pre-tax retirement and HSA contributions lower the income that counts. Confirm with your tax professional.

Questions people ask

Sources: CMS QHP Landscape PY2026 Individual Medical file (data.healthcare.gov, snapshot August 4, 2026) for every Marketplace premium, benchmark, deductible, plan count and insurer count; HHS 2025 poverty guidelines (90 FR 5917) and IRS Rev. Proc. 2025-25 for the credit maths; U.S. Census Bureau county population estimates for the size cut-offs; carrier rate tables used by our advisors for private ranges. Figures are monthly, non-tobacco, before any credit unless stated, and can change before Open Enrollment. Tax rules summarised here are general; confirm with your tax professional.