Health Insurance Options by StatesFederal vs. State Based Health Exchanges

Alabama Alaska Arizona Arkansas California
Colorado Connecticut Delaware Florida Georgia
Hawaii Idaho Illinois Indiana Iowa
Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri
Montana Nebraska Nevada New Hampshire New Jersey
New Mexico New York North Carolina North Dakota Ohio
Oklahoma Oregon Pennsylvania Rhode Island South Carolina
South Dakota Tennessee Texas Utah Vermont
Virginia Washington West Virginia Wisconsin Wyoming


The Marketplace in Your State

The health insurance marketplace (also known as the Health Insurance Exchange) is where those who don’t have health insurance through an employer, parent, Medicare, or Medicaid, can enroll in a healthcare plan.

There is a health insurance marketplace in every state; some are operated by the state and some by the federal government.

Those living in states with a health insurance marketplace operated by the federal government use the enrollment platform. However, there are 13 states with their own state-based health insurance marketplaces:

  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Idaho
  • Maryland
  • Massachusetts
  • Minnesota
  • Nevada
  • New York
  • Rhode Island
  • Vermont
  • Washington

How Much Does Health Insurance Cost Nationwide?

Americans pay wildly different health insurance premiums. This expense is no longer determined by health condition or gender (thanks to the Affordable Care Act) but is instead dictated by a range of different factors: type of plan (employer, individual or family), the state, age, tobacco use, and size of the employing company.

For marketplace premiums in 2020, the average annual bronze plan is $3,972, silver is $5,304, and gold is $6,012. 

In 2019, average annual premiums for covered workers reached $7,188 for individual coverage and $20,576 for family coverage. Individuals and families contributed an average of $1,242 and $6,015 respectively, with employers paying most of the bill. 

How to Manage Healthcare Costs

1. Match Health Insurance with Your Needs

Although no longer mandatory in most states, everyone should have health insurance to cover them should major healthcare issues arise. The type of coverage required for more routine expenses, however, depends on your unique health. 

For example, a young and fit individual who rarely sees a doctor is better suited to a plan with a high-deductible than an individual in poorer health. The premiums will be more expensive, but it should reduce out-of-pocket expenses for medical treatment.

2. Know What Your Plan Covers

Just because you have a health insurance plan, it doesn’t mean you’re covered for everything.  Ideally, before you enroll, you should pay attention to precisely what treatments are covered, the out-of-pocket costs and caps on expenses covered. 

3. Have Money Set Aside for Out-Of-Pocket Expenses

When the time comes to pay out-of-pocket expenses, don’t be caught off-guard. Look at your plan’s out-of-pocket expenses and set up an emergency savings fund based on how much you think you’ll require annually. 

4. Don’t Put Off Long-Term Healthcare Decisions

Failure to plan can be a big mistake, especially in the realm of health insurance. Making plans for long-term care and saving to afford care should all be part of your overall plan. The sooner you plan for your long-term healthcare decisions, the better.


Can You Get Health Insurance in a Different State?

No. You can only buy health insurance in the state in which you have your permanent address. Should you move to another state, a separate health insurance plan is required. If you have permanent residences in more than one state, you can purchase a plan in either state.

Which States Still Require Health Insurance?

The individual mandate law that requires individuals to have health insurance does not apply anymore at the federal level. However, there are still some states that have an individual mandate at the state level. 

If you live in Massachusetts, New Jersey, Vermont, California, Rhode Island, or D.C., you may have to pay a penalty for not having health insurance: To avoid a penalty, individuals can enroll in a health insurance plan during the open enrollment period.

Which States Have the Cheapest Health Insurance?

While many have access to quality health care, other Americans face barriers to the costs involved. Studies show the five states with the most affordable healthcare costs:

  1. Iowa
  2. North Dakota
  3. Hawaii
  4. Vermont
  5. Massachusetts 

Best States for Healthcare 2020

MoneyRates’ annual state healthcare comparison study compares states with metrics such as overall condition, affordability, and coverage. 

The top 5 states for healthcare in 2020:

    1. Massachusetts. The state has a number-one ranking in most categories. 
    2. Connecticut. Connecticut regularly performs well in healthcare condition comparisons but is also amongst the ten most expensive states for health insurance.
    3. North Dakota. The state’s nursing staff rank number one and the only category it received a rating of less than average was in infant survival.
    4. Iowa. Amongst the top ten rankings for coverage, nursing care staffing, and affordability.
    5. Vermont. In the top ten for health insurance coverage, reported health status yet frail for physicians’ office staffing.