Verified against KFF and CMS 2026 marketplace filings
Quick Answer: Four states have a lowest-cost Silver health plan priced $200 or more above the 2026 national average of $611 a month. Vermont leads at $1,289, more than double the national figure, followed by Wyoming at $1,089, West Virginia at $1,036, and Alaska at $1,019. Rural insurer scarcity and small risk pools drive the gap in three of these states, while Vermont’s community rating rules spread cost differently across all ages rather than charging older enrollees more. These figures reflect the sticker price insurers charge before any subsidy, and many enrollees in these states qualify for premium tax credits that lower their actual net cost well below the amounts shown here.
A Silver plan is the benchmark tier every ACA marketplace shopper compares against. Most people assume their state’s price reflects a national norm. In four states, it does not, by a wide and specific margin.
Our research team reviewed 2026 KFF marketplace premium data, cross-checked against CMS filings and Becker’s Payer Issues analysis, to identify exactly which states carry the steepest Silver plan premiums and why.
What Is a Silver Health Plan?
A Silver health plan is one of four ACA marketplace metal tiers, sitting between Bronze and Gold in both premium and coverage generosity. Silver plans typically split costs so the insurer pays roughly 70 percent of care and the enrollee pays 30 percent, before reaching the deductible. Silver is the only tier eligible for cost-sharing reductions, a subsidy that lowers deductibles and copays for enrollees earning between 100 and 250 percent of the federal poverty level. Because of this exclusive eligibility, Silver is also the tier insurers and regulators use to calculate premium tax credits nationwide, making it the standard reference point for comparing state-to-state cost differences. Every state offers this same tier structure, though the dollar amount behind each tier varies enormously by location, as the next section shows.
The 4 States Where Silver Plans Cost $200 or More Above Average
The national average lowest-cost Silver premium for 2026 is $611 a month, based on KFF’s analysis of CMS marketplace filings for a 40-year-old, weighted by county plan selections. Four states clear a $200 gap above that figure.
| State | 2026 Lowest-Cost Silver Premium | Amount Above National Average |
|---|---|---|
| Vermont | $1,289 | +$678 |
| Wyoming | $1,089 | +$478 |
| West Virginia | $1,036 | +$425 |
| Alaska | $1,019 | +$408 |
Source: KFF marketplace premium data via Becker’s Payer Issues, 2026 plan year.
Vermont’s premium is more than double the national average, the widest gap of any state in the country. No other state comes close to matching that spread.
Why Do These 4 States Have Such High Premiums?
Two distinct forces explain this gap, and they are not the same force in every state.
Wyoming, West Virginia, and Alaska share a common driver: rural insurer scarcity. Each of these states has very few insurers competing on its marketplace, sometimes only one, and small, sparsely distributed populations across large geographic areas. Fewer competing insurers and smaller risk pools both push premiums upward, since costs cannot spread across as many enrollees and there is little competitive pressure to hold prices down.
Vermont’s driver is different: community rating without age adjustment. Vermont and New York are the only two states that prohibit insurers from charging older enrollees more than younger ones for the same plan. This spreads cost differently across the population rather than concentrating high costs on older applicants. The result raises the baseline premium for everyone, including younger, healthier enrollees who would pay far less under the standard age-rating formula used everywhere else.
Important for 2026: These premium figures reflect the expiration of enhanced Affordable Care Act premium tax credits at the end of 2025. If Congress restores or extends these credits, net costs for subsidized enrollees in every state, including the four listed here, could change substantially from the sticker prices shown.
Which States Have the Cheapest Silver Plans by Comparison?
The gap becomes even more visible next to the least expensive states in the country.
| State | 2026 Lowest-Cost Silver Premium | Amount Below National Average |
|---|---|---|
| New Hampshire | $394 | -$217 |
| Maryland | $403 | -$208 |
| Minnesota | $437 | -$174 |
Source: KFF marketplace premium data via Becker’s Payer Issues, 2026 plan year.
A Vermont enrollee pays more than three times what a New Hampshire enrollee pays for the same tier of coverage. Both states border each other, which shows how much state-level insurance regulation and market structure matter, independent of regional healthcare costs.
What This Means If You Live in a High Cost State
A high sticker price does not always translate to a high net cost. Premium tax credits reduce what many enrollees actually pay, based on income relative to the federal poverty level, and those credits scale with the local cost of the benchmark Silver plan. This is the same subsidy mechanic we cover in detail in our breakdown of why premiums jumped in 2026. In practice, this means enrollees in Vermont, Wyoming, West Virginia, and Alaska may receive proportionally larger subsidies than enrollees in cheaper states, partially offsetting the higher sticker price for those who qualify.
Enrollees who do not qualify for a subsidy, typically those earning above 400 percent of the federal poverty level, feel the full weight of these state-level gaps with no offset at all.
How to Check Your Own State’s Silver Plan Cost
Confirm your own state and county-specific rate before assuming a national or state average applies to you.
- Visit Healthcare.gov or your state’s marketplace exchange and enter your ZIP code.
- Compare the lowest-cost Silver plan premium shown against the $611 national average cited here.
- Use the HealthCare.gov subsidy calculator to see your net cost after any premium tax credit you qualify for.
- Check whether your state runs its own exchange, since state-run marketplaces sometimes show different plan options than the federal HealthCare.gov listings.
Frequently Asked Questions
Which state has the most expensive Silver health plan in 2026?
Vermont has the most expensive lowest-cost Silver health plan in the nation for 2026, averaging $1,289 a month. This is more than double the $611 national average and reflects Vermont’s community rating rules, which prohibit charging older enrollees more than younger ones for identical coverage.
Why is health insurance so expensive in Wyoming and Alaska?
Wyoming and Alaska have very few insurers competing on their ACA marketplaces, combined with small, widely dispersed populations. Fewer competing insurers and smaller risk pools both push premiums higher, since costs cannot spread across as many enrollees as in more densely populated states.
What is the national average cost of a Silver health plan in 2026?
The national average lowest-cost Silver health plan for 2026 is $611 a month for a 40-year-old, according to KFF’s analysis of CMS marketplace filings, weighted by county plan selections across the country.
Does a higher premium mean better health insurance coverage?
Not necessarily. A higher premium in a specific state often reflects market conditions like insurer scarcity or state regulations, not richer benefits. Silver plans in every state cover the same essential health benefits required under the ACA, regardless of the premium charged.
Will these 2026 premiums change if federal subsidies are extended?
The sticker premiums listed here would likely stay the same, since they reflect what insurers charge before any subsidy. However, the net amount enrollees actually pay could change substantially if Congress extends or restores the enhanced premium tax credits that expired at the end of 2025.
The Bottom Line on State Cost Gaps
Vermont, Wyoming, West Virginia, and Alaska all carry Silver plan premiums at least $200 above the national average, for genuinely different underlying reasons depending on the state. Before assuming your own cost matches any average cited here, check your specific state and county rate, and confirm your subsidy eligibility. The net price you pay can differ sharply from the sticker premium. Understanding what you’ll actually pay out of pocket matters just as much as the premium itself when comparing your total annual cost.
This guide provides general insurance education only. Premium figures reflect 2026 marketplace filings and may not represent your specific plan, county, or subsidy eligibility. Rates and subsidy rules can change based on future legislation. Consult HealthCare.gov, your state marketplace, or a licensed insurance professional for guidance specific to your situation.
Content reviewed: July 2026. Premium data reflects KFF’s analysis of CMS marketplace filings for the 2026 plan year, as reported by Becker’s Payer Issues.
