Healthcare Out-of-Pocket Costs by State

The average monthly Silver plan premium hit $752 in 2026, a 21% jump in a single year. That figure doesn't include deductibles, copays, or the bills that arrive after a hospitalization.

Where you live shapes every layer of that cost. Texas residents face average total healthcare costs of $8,406 per year. Minnesota residents pay considerably less. The gap between the cheapest and most expensive states now exceeds $3,000 annually, and it compounds over a lifetime.

The States With the Highest Out-of-Pocket Costs

Texas leads the country with $8,406 in average annual healthcare costs per person. Nevada follows at $8,348, and Idaho comes in third at $8,148. Utah rounds out the top tier at $7,522.

These states share a common profile: large uninsured populations, limited Medicaid expansion penetration, and insurance markets with fewer carriers competing for customers. Fewer competitors means less pressure on premiums and cost-sharing structures. Texas, notably, never expanded Medicaid under the ACA, leaving a coverage gap that pushes costs onto individuals and inflates prices across the market.

Where Costs Are Actually Manageable

The Northeast and upper Midwest consistently produce lower out-of-pocket burdens, even though premiums in some of those states are higher on paper. Vermont, Massachusetts, and Minnesota benefit from tighter insurance regulation, larger risk pools, and robust provider networks that negotiate lower rates.

The counterintuitive reality: a higher monthly premium can mean lower total annual spending if deductibles and cost-sharing are structured better. A $900-per-month plan with a $1,000 deductible costs less than a $600-per-month plan with a $7,000 deductible for anyone who actually uses medical care. States that regulate plan design more aggressively tend to produce better outcomes for people who get sick.

California sits in the middle of the pack. Covered California, the state's marketplace, maintains more standardized plan designs than most states, which limits the worst-case deductible exposure. Average annual out-of-pocket spending in California runs roughly $6,200, below the national median despite the state's high cost of living in other categories.

How Premiums and Total Costs Diverge

The 2026 premium spike of 21% nationally did not land evenly. States with federally facilitated marketplaces and limited insurer competition absorbed the largest increases. Wyoming, Mississippi, and West Virginia saw premium increases above 25% year-over-year. States running their own exchanges, including California, New York, and Colorado, kept increases closer to 14-16%.

Premium tax credits through the ACA marketplace offset some of this for lower-income households, but the credits phase out at 400% of the federal poverty level. A single adult earning $60,000 in 2026 sits above that threshold in most states and absorbs the full premium increase with no subsidy cushion.

Deductibles also climbed. The average individual deductible on a Bronze plan now exceeds $7,400 nationally. That means most enrollees in those plans effectively self-insure for the first $7,400 of medical spending every year, making the premium a bet on staying healthy rather than real insurance coverage.

If you're planning a move partly around healthcare costs, the True Cost of Living in High-Tax States post shows how medical spending interacts with taxes to reshape your real take-home picture. Retirees specifically should also read our breakdown of the Best States for Retirees to Avoid Taxes, since Medicare gaps and supplemental coverage costs vary significantly by state and can dwarf what working-age adults pay.

What This Means for Where You Live

Healthcare costs are not fixed expenses. They are a direct function of state policy, market structure, and the specific plan options available in your zip code. Moving from Texas to Minnesota could save a family of four $6,000 to $9,000 annually in healthcare spending alone, before accounting for any tax differences.

That math changes the calculus on states that look cheap on housing or income tax. A Texas resident might avoid state income tax but spend $2,000 more per year per person on healthcare than a comparable resident of a higher-tax state. For a two-income household with two kids, that gap can exceed $8,000 annually, which is more than the income tax savings in many scenarios.

Use our state comparison calculator to model total cost of living including healthcare, taxes, and housing side by side.

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Key Takeaways

• The national average Silver plan premium is $752 per month in 2026, up 21% year-over-year, with states like Wyoming and Mississippi seeing increases above 25%.
• Texas has the highest average annual healthcare costs at $8,406 per person, followed by Nevada at $8,348 and Idaho at $8,148.
• The spread between the highest and lowest-cost states exceeds $3,000 per person per year, meaning a family of four could save $12,000 annually by choosing the right state.

Compare healthcare costs alongside taxes and cost of living for every state at liveordiehere.com.