MAY 2026 UPDATE: Added a section on how 2026 ACA increases translate to employer group plan renewals, a cost-control playbook for high-cost states, and expanded FAQ answers with specific figures. Premium data reflects ACA Silver plan averages for a 40-year-old, sourced from marketplace rate filings.
If you manage benefits, this is the chart you can't unsee.
Health insurance premiums jumped again in 2026, and the increases are wildly uneven by state.
This is huge for employers and employees deciding whether coverage is still affordable.
Quick Answer: Health Insurance Premium Increase 2026 by State
Premiums rose across most states in 2026, with the U.S. average monthly Silver plan reaching $752, up 21% year-over-year. Vermont leads at $1,224/month, while Maryland is lowest at $480/month. The biggest spike is Arkansas at +67% annually. These gaps reshape employer budgets and employee affordability.
What Counts as a "Premium" in Health Insurance?
An insurance premium is the monthly price paid to keep coverage active. It's separate from deductibles, copays, and coinsurance. When premiums rise, the cost to simply stay covered goes up--before anyone uses care.
If your team still mixes up premium vs deductible, use this quick explainer in our insurance premiums guide.
The 2026 Map: Average Health Insurance Premiums by State
This visualization reflects ACA marketplace Silver plan averages for a 40-year-old and shows how uneven 2026 pricing has become.
Key Takeaways (No Fluff)
- Vermont has the highest monthly premium: $1,224.
- Maryland is the lowest at $480.
- Arkansas had the fastest annual increase at +67%.
- The U.S. average hit $752/month, up 21% since 2025.
Table 1: U.S. Average vs Highest and Lowest States (2026)
| Category | State | Monthly Premium | Annual Change |
|---|---|---:|---:|
| Highest | Vermont | $1,224 | +6% |
| Lowest | Maryland | $480 | +16% |
| U.S. Average | -- | $752 | +21% |
Table 2: Health Insurance Premium Increase 2026 by State (Full List)
| Rank | State | Avg Monthly Premium | Annual Change |
|---:|---|---:|---:|
| 1 | Vermont | $1,224 | 6% |
| 2 | Wyoming | $1,119 | 25% |
| 3 | West Virginia | $1,093 | 14% |
| 4 | New York | $1,090 | 5% |
| 5 | Alaska | $1,037 | -5% |
| 6 | Nebraska | $960 | 29% |
| 7 | Illinois | $888 | 30% |
| 8 | Florida | $859 | 33% |
| 9 | Connecticut | $859 | 21% |
| 10 | Louisiana | $827 | 26% |
| 11 | Texas | $826 | 35% |
| 12 | Arkansas | $823 | 67% |
| 13 | Utah | $821 | 22% |
| 14 | New Mexico | $800 | 26% |
| 15 | North Carolina | $800 | 21% |
| 16 | Nevada | $792 | 34% |
| 17 | Kansas | $787 | 23% |
| 18 | Tennessee | $775 | 39% |
| 19 | Maine | $771 | 24% |
| 20 | Montana | $763 | 20% |
| 21 | Washington | $761 | 40% |
| 22 | Delaware | $759 | 31% |
| 23 | Mississippi | $756 | 42% |
| 24 | Pennsylvania | $750 | 23% |
| 25 | Missouri | $742 | 20% |
| 26 | Oklahoma | $739 | 23% |
| 27 | South Dakota | $734 | 6% |
| 28 | Georgia | $729 | 32% |
| 29 | California | $728 | 11% |
| 30 | Massachusetts | $725 | 10% |
| 31 | Wisconsin | $722 | 19% |
| 32 | Michigan | $719 | 28% |
| 33 | Colorado | $703 | 27% |
| 34 | North Dakota | $700 | 12% |
| 35 | Alabama | $691 | 23% |
| 36 | Arizona | $685 | 29% |
| 37 | New Jersey | $669 | 15% |
| 38 | Kentucky | $662 | 23% |
| 39 | South Carolina | $657 | 22% |
| 40 | Oregon | $643 | 5% |
| 41 | Ohio | $635 | 18% |
| 42 | Iowa | $624 | 23% |
| 43 | Washington, D.C. | $618 | 8% |
| 44 | Rhode Island | $589 | 23% |
| 45 | Hawaii | $583 | 11% |
| 46 | Indiana | $558 | 29% |
| 47 | Minnesota | $556 | 23% |
| 48 | Idaho | $537 | 10% |
| 49 | Virginia | $514 | 22% |
| 50 | New Hampshire | $491 | 32% |
| 51 | Maryland | $480 | 16% |
Table 3: Top 10 Annual Increases (2026)
| State | Annual Change |
|---|---:|
| Arkansas | 67% |
| Mississippi | 42% |
| Washington | 40% |
| Tennessee | 39% |
| Texas | 35% |
| Nevada | 34% |
| Florida | 33% |
| Georgia | 32% |
| New Hampshire | 32% |
| Delaware | 31% |
Why Are Health Insurance Premiums Rising in 2026?
This is the part most people miss.
Premiums don't rise because insurers feel like it. They rise because claims costs rise, and in 2026 several specific forces are driving that higher than they have in years.
GLP-1 drug adoption. Obesity and diabetes medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) are now mainstream employer plan claims. A single enrollee using a branded GLP-1 drug adds $400 to $800 annually to a plan's per-member cost. For a 50-person group, widespread adoption can add $30,000 or more to annual claims before any other cost driver is considered.
Post-COVID utilization normalization. Deferred elective procedures from 2020 through 2022 are now being completed. Orthopedic surgeries, colonoscopies, cardiac stress tests, and cancer screenings that were postponed are all being claimed at once, pushing utilization well above pre-pandemic baselines.
Hospital consolidation in high-cost states. In states like Texas, Florida, and Nevada -- all in the top 12 by 2026 premium -- hospital system mergers have reduced insurer leverage in contract negotiations. When a single health system controls 60-70% of hospital beds in a metro area, insurers pay higher rates or lose network access. Those higher rates flow directly into premiums.
Insurer market exits reducing competition. Several large carriers have pulled out of ACA marketplace counties in specific states. Fewer competing insurers means less downward price pressure. States with three or fewer active marketplace insurers consistently show higher premiums than states with five or more.
For a deeper look at how these dynamics affect your renewal, see our health insurance 101 guide for employers.
What These Increases Mean for Employer-Sponsored Group Plans
The tables above show ACA marketplace rates, which reflect the individual market. Most employers buy fully insured or level-funded group plans -- a different product with a different pricing mechanism.
The gap in 2026: Small group plan renewals in 2026 are averaging 8 to 12% increases, compared to the 21% ACA marketplace average. That gap exists for three reasons:
- Different risk pools. Employer groups are underwritten based on their own claims history. A healthy 20-person workforce does not automatically pay what the broader individual market pays.
- Employer contribution structures. Employers typically absorb a share of any renewal increase, partially shielding employees from the full sticker-price jump.
- Plan design flexibility. Group plans can adjust deductibles, networks, and copays in ways ACA marketplace plans cannot, creating more levers to control the renewal number.
Where group and marketplace converge: Small groups with fewer than 10 employees, high utilization history, or employees in states with thin carrier competition will see renewal increases much closer to the marketplace figures in Table 2. Arkansas and Mississippi employers are particularly exposed.
The level-funded threshold: For employers with 25 or more employees, a migration from fully insured to a level-funded plan structure often produces 10 to 20% lower monthly costs compared to a traditional renewal. Level-funded plans cap the employer's monthly liability and return unused claims reserves if the group runs healthy. If you are in Texas, Florida, Tennessee, or any state above $800/month in the table, this conversation belongs on your 2026 renewal checklist.
2026 Premium Trends Employers Should Track
Rising premiums are not landing evenly. The states seeing the largest increases -- Arkansas (+67%), Mississippi (+42%), Washington (+40%), Tennessee (+39%) -- share a common profile: limited carrier competition, recent hospital consolidation, or heavy GLP-1 drug adoption in the working-age population.
For employers, the actionable signal is this: if your workforce is concentrated in a state above the national average in Table 2, your next group renewal will likely reflect that state's trend, not the national average. Budget accordingly.
Employers in low-premium states like Maryland ($480), New Hampshire ($491), and Virginia ($514) still face meaningful increases (16%, 32%, and 22% respectively) despite lower starting points. A 32% increase on $491 adds $157 per month per employee -- over $1,800 annually per enrolled worker.
What Employers Can Do About It (Without Guessing)
If premiums are rising in your state, you need a structure that limits exposure.
Smart moves that consistently cut costs:
- Compare plan structures: group health plan vs. insurance (2026)
- Use pre-tax strategies: Section 125 plan complete guide
- Rework benefits design: group health insurance alternatives
- Improve affordability for small teams: best small business health insurance (2026)
2026 Cost-Control Playbook for Employers in High-Premium States
Links are useful. Numbers are better. Here are three approaches that are moving the needle for Summit Health Benefits clients in high-cost states right now.
1. Section 125 pre-tax structure: immediate 7.65% offset
Every dollar employees contribute to premiums through a Section 125 cafeteria plan is exempt from employer FICA matching (6.2% Social Security + 1.45% Medicare). For a 20-person company where employees contribute an average of $4,800 annually toward premiums, that is $96,000 in pre-tax elections generating $7,344 in annual FICA savings -- enough to fund plan administration and begin offsetting the renewal increase. This works on top of any plan type, including fully insured, level-funded, or HealthShare. See our FICA tax savings guide for the full calculation by headcount.
2. Level-funded plan migration: 10-20% lower than fully insured renewals
For groups of 25 or more, level-funded plans cap monthly employer liability and include stop-loss protection above a per-member threshold (typically $20,000 to $50,000 per claim). In Texas, Florida, and Tennessee -- three of the top 12 highest-premium states -- Summit clients who migrated to level-funded structures in 2025 averaged 14% lower total plan costs compared to their prior fully insured renewal. If you are currently fully insured and renewing above $800/month average, request a level-funded quote before accepting your renewal.
3. Reference-based pricing for groups above 50 employees
Reference-based pricing (RBP) plans reimburse providers at a multiple of Medicare rates (typically 120 to 200%) rather than negotiated network rates. In states where hospital consolidation has inflated network rates -- Florida, Texas, Nevada -- this can reduce inpatient and outpatient claims costs by 15 to 30%. RBP requires member advocacy support and provider balance-billing protection, which your TPA or broker should include. It is not appropriate for all groups, but it is worth modeling for any employer in a high-consolidation market.
For a full breakdown of how these approaches combine with a Section 125 cafeteria plan, contact Summit Health Benefits for a no-cost cost review.
The Bottom Line
2026 is a reset year. Premiums are rising, state gaps are widening, and employers who plan early will win on cost and retention.
If you want a clear plan to reduce your health insurance spend without cutting coverage, explore our employee benefits strategy guide or contact Summit Health Benefits for a cost review.
FAQ
What is an insurance premium?
An insurance premium is the monthly price you pay to keep a health plan active, regardless of whether you use any care that month. It is separate from deductibles (what you pay before insurance covers costs), copays (flat fees per visit), and coinsurance (your percentage share after the deductible). When a plan's premium rises, your fixed monthly cost increases even if your deductible and copay structure stays the same.
What is a health insurance premium?
The recurring monthly cost for a health plan, paid by the employee, the employer, or split between both. For ACA marketplace plans, premiums vary by age, location, and plan tier (Bronze, Silver, Gold, Platinum). Employer-sponsored group plan premiums are typically split, with the employer covering 60 to 80% of the total cost and the employee paying the remainder through payroll deduction.
What is the average health insurance premium in 2026?
The U.S. average monthly premium for ACA Silver plans is $752 in 2026, up 21% from 2025. For employer-sponsored group plans, the average total premium (employer plus employee share combined) is approximately $650 to $850 per month for single coverage, with wide variation by state and plan design.
Why are premiums increasing in 2026?
Four main drivers: GLP-1 obesity drug adoption adding $400 to $800 per enrolled member annually, post-COVID utilization catch-up, hospital consolidation reducing insurer negotiating leverage in high-cost states, and insurer market exits in select counties reducing price competition. The combination pushed the national ACA average 21% higher year-over-year.
Which state has the highest health insurance premiums?
Vermont is highest in 2026 at $1,224/month for a 40-year-old on a Silver ACA plan. Vermont's high costs reflect a small individual market with limited carrier competition and a regulatory structure that limits the insurer options available to residents.
Which state has the lowest health insurance premiums?
Maryland is lowest in 2026 at $480/month. Maryland operates a state-based exchange (Maryland Health Connection) with an active reinsurance program that uses federal pass-through funding to lower premiums for all marketplace enrollees -- one of the most effective state-level cost-control models in the country.
What is the biggest premium increase by state in 2026?
Arkansas shows the largest annual jump at +67%. This follows years of below-market pricing by carriers who have since corrected to reflect actual claims costs in the state. A single large carrier raising rates sharply after accumulating losses is the most common cause of outsized single-year increases.
Are 2026 increases the same for employer group plans and ACA marketplace plans?
No. The tables above show ACA individual marketplace rates. Employer-sponsored small group plan renewals averaged 8 to 12% in 2026 -- well below the 21% ACA marketplace average. The gap exists because group plans are underwritten on a specific employer's claims history, not the broader individual market risk pool. Large group employers (50+ employees) with strong claims history can sometimes hold renewals to 4 to 6%.
Why are Vermont and Wyoming so much more expensive than other states?
Both states have small populations, limited carrier competition, and rural hospital systems with significant pricing power. When only one or two insurers actively compete on a state's marketplace, there is no competitive pressure to lower premiums. Vermont and Wyoming each have fewer than three active marketplace carriers in most counties. States with five or more competing insurers consistently show lower-than-average premiums in national comparisons.
Do ACA premium tax credits offset the 2026 increases for employees?
For employees buying ACA marketplace coverage, income-based premium tax credits cap their contribution at a percentage of household income (typically 2 to 10% of income depending on the income tier). These credits automatically adjust when premiums rise, partially insulating lower-income enrollees. However, employees offered affordable employer-sponsored coverage are generally not eligible for marketplace subsidies, regardless of how high premiums get.
How often do health insurance premiums change?
ACA marketplace premiums reset every January 1. Enrollees can compare updated rates and switch plans during the annual open enrollment period (November 1 to January 15 for most states). Employer group plan premiums renew on the plan's anniversary date, most commonly January 1 or July 1. Outside of open enrollment or a qualifying life event, neither marketplace nor employer plan participants can make coverage changes.
How can employers lower health insurance premiums?
The most reliable approaches in 2026: implement a Section 125 pre-tax structure to recover FICA savings on employee contributions (see Section 125), migrate to a level-funded plan if you have 25 or more employees, model reference-based pricing if you are in a high-consolidation hospital market, and compare plan structures to identify whether your current fully insured design still makes sense at today's renewal price.