West Virginia, Vermont top list of states where health insurance costs the most
A new analysis from the personal finance advisors at WalletHub looked at the cost of health insurance households face in all 50 states, adjusting for median income, in an effort to understand where people are paying the most for medical coverage. The firm looked at the total costs families pay, including both premiums and deductibles.
In its report, the firm cited data from the Kaiser Family Foundation revealing that in 2025 alone, premiums spiked 5% for individuals and 6% for families on average nationwide. But that information doesn’t tell us much about what is happening state by state. As WalletHub notes, health insurance premiums may consume 5% of the median household income in affordable states, but in others that number can be as high as 21%.
For its comparative analysis ranking the price tag of plans in all 50 states, the group said it looked exclusively at offerings ranked at the silver level, as they provide the best balance of deductibles and premiums, painting a more honest picture of how they impact household finances.
The states, ranked from where insurance is most to least expensive based on median income, line up as follows:
Rank | State | Cost of insurance as a % of median household income. |
1. | West Viginia | 20.86% |
2. | Vermont | 19.05% |
3. | Wyoming | 17.16% |
4. | Arkansas | 14.87% |
5. | Mississippi | 14.05% |
6. | Alaska | 13.18% |
7. | Louisiana | 12.58% |
8. | Tennessee | 12.19% |
9. | Alabama | 11.85% |
10. | Montana | 11.27% |
11. | Maine | 11.18% |
12. | Nebraska | 11.14% |
13. | Oklahoma | 11.11% |
14. | New York | 11.00% |
15. | Kentucky | 10.87% |
16. | Florida | 10.85% |
17. | New Mexico | 10.58% |
18. | Kansas | 10.50% |
19. | North Carolina | 10.49% |
20. | South Dakota | 10.26% |
21. | Missouri | 10.25% |
22. | Texas | 9.95% |
23. | South Carolina | 9.76% |
24. | Delaware | 9.68% |
25. | Connecticut | 9.48% |
26. | Georgia | 9.37% |
27. | Wisconsin | 9.32% |
28. | Illinois | 9.14% |
29. | North Dakota | 8.66% |
30. | Ohio | 8.62% |
31. | Pennsylvania | 8.54% |
32. | Michigan | 8.45% |
33. | Iowa | 7.95% |
34. | Indiana | 7.89% |
35. | Arizona | 7.79% |
36. | Utah | 7.74% |
37. | Oregon | 7.73% |
38. | Nevada | 7.59% |
39. | Idaho | 7.47% |
40. | Washington | 7.21% |
41. | Colorado | 6.72% |
42. | Rhode Island | 6.67% |
43. | Hawaii | 6.37% |
44. | California | 6.32% |
45. | New Jersey | 6.23% |
46. | Minnesota | 5.89% |
47. | Virginia | 5.86% |
48. | Massachusetts | 5.49% |
49. | New Hampshire | 4.77% |
50. | Maryland | 4.66% |
As the chart shows, despite being known as a lower-income state with a lower-than-average cost of living, West Virginia has its residents paying more, on average, for medical coverage than any other single state.
WalletHub noted this is due to a “combination of high premiums and low incomes.”
“The average monthly health care premium for a silver plan in West Virginia is $1,036, which is the third-highest in the country. At the same time, West Virginia has the second-lowest median household income, at $59,608,” the group wrote.
Comparatively, the opposite is true for Maryland, where the median income in 2024 was $102,900, making it the third-highest among all states. Meanwhile, insurance premiums were some of the lowest in the country.
Zooming in on other high-cost states
Coming in second is Vermont. Despite having a median household income of $81,203—ranking 19th in the country—residents dedicate 19% of their income just to health insurance.
The reason is the high cost of premiums alone, WalletHub said. In Vermont, the monthly cost just to access insurance is $1,289 on average, not including any deductible payments, which is disproportionately high.
A similar thing is happening in Wyoming, ranked third on the WalletHub list. On average, premiums alone are 17% of the state’s median monthly income.
“While that’s significantly lower than the percentages spent in West Virginia and Vermont, it’s still very expensive,” WalletHub wrote, adding that residents of the state “pay the second-highest monthly health insurance premiums in the country, at $1,089.”
For more, read WalletHub’s full analysis by clicking here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.