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The 5 Worst States for 2021 Prices

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Health insurance regulators and Affordable Care Act public exchange plan managers are celebrating the fact that, in most states, prices for 2021 individual major medical insurance will be flat, or a little lower.

But, of course, individual coverage in most states still costs an arm and a leg.


  • Links to plan choice and plan price summary reports are available here.
  • An article about state-level health insurance market competition is available here.

The ACA public exchange system helps people use federal premium subsidies to pay for health coverage. The benchmark plan used to calculate the subsidies is the second-lowest-cost silver plan, or mid-tier plan, in a county.

The Centers for Medicare and Medicaid Services (CMS) runs, an ACA public exchange system for states that are unwilling or unable to run their own ACA exchange programs.

In the states, the full average cost of benchmark plan coverage for a 27-year-old will fall to $403 per month 2021, from $414 this year, according to CMS.

In other words: The monthly premium will be 2.7% lower next year, but a typical healthy uninsured 27-year-old who earns more than 400% of the federal poverty level, or $51,040 per year for a single person, will have to pay about $4,800 per year for coverage that may come with a narrow network, a $7,000 annual deductible, and little coverage for anything other checkups before an enrollee meets the deductible.

Because the premiums and out-of-pocket costs for unsubsidized enrollees is so high, the number of unsubsidized exchange plan users fell to 3.4 million in 2019, from a peak of 6.3 million in 2016, even as the number of subsidized users increased to 8.8 million, from 8.2 million, according to CMS figures.

ACA critics say the full cost of ACA exchange plan coverage is high because ACA individual major medical insurance rules and programs were poorly designed.

ACA supporters contend that prices are higher, and the number of unsubsidized enrollees is lower, because the administration of President Donald Trump has declined to support the ACA provisions, such as the ACA individual coverage mandate, that were supposed to encourage young, healthy people to pay for coverage.

Whatever the reasons, the cost of benchmark plan coverage is more than $500 per month for a 27-year-old in five states.

For a list of the highest-cost states, see the slideshow above. (Wiggle your pointer over the first slide to make the control arrows work.(

— Read Agents Work to Hold 2021 Individual Major Medical Market Togetheron ThinkAdvisor.

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