The US States Where Health Insurance Costs Take The Biggest Share Of Household Income

Health insurance costs vary significantly across the United States, with households in some states paying a much larger share of their income toward premiums than those in other parts of the country.

To examine these differences, here at ProfitDuel, we have analyzed average monthly and annual health insurance costs in 2026 alongside median household income, population size and the percentage of residents without health insurance coverage across all 50 states.

The analysis found that West Virginia has the highest health insurance burden relative to household income, while Maryland has the lowest. The data also reveals substantial differences in premium costs and how much they have changed over the past year.

Key Takeaway: West Virginia has the highest health insurance burden

West Virginia has the highest health insurance costs relative to household income in the US.

The average monthly premium is $1,093, equivalent to an annual cost of $13,116. With a median household income of $60,798, premiums account for 21.6% of annual household income. This comes on the back of a study we conducted last year which found that West Virginia spends the most on healthcare.

Wyoming has the second-highest proportion, with its $13,428 annual premium representing 17.8% of median household income.

Vermont also records a figure of 17.8%. However, its average annual premium is higher at $14,688, which is the highest of any state in the analysis.

Louisiana ranks fourth, with annual premiums of $9,924 representing 16.3% of median household income, followed by Arkansas at 15.9%.

The 10 states where premiums take the biggest share of income

The figures highlight why looking at premiums in isolation can give a different picture of how they compare with household earnings.

New York, for example, has one of the highest annual premiums in the country at $13,080. Its median household income of $85,820 means the cost represents 15.2% of income.

Louisiana has a considerably lower annual premium of $9,924, but its median household income of $60,986 means premiums account for a higher proportion of income at 16.3%.

US states ranked by health insurance premiums as a percentage of median household income in 2026

Where are health insurance premiums most expensive?

Vermont has the highest average monthly premium at $1,224, giving an annual cost of $14,688.

Wyoming follows at $1,119 per month, while West Virginia and New York record average monthly costs of $1,093 and $1,090, respectively.

Alaska is the fifth state where average monthly premiums exceed $1,000, at $1,037.

States with the highest average monthly premiums

In comparison, Maryland has the lowest average monthly premium at $480, followed by New Hampshire at $491 and Virginia at $514.

Idaho also has a relatively low average premium at $537 per month, while Minnesota records $556.

Maryland has the lowest insurance burden

Maryland has the lowest health insurance cost relative to median household income in the dataset.

The state's average monthly premium of $480 results in an annual cost of $5,760. Against a median household income of $102,905, this represents 5.6% of household income.

New Hampshire follows at 5.9%, with Virginia at 6.7%, Hawaii at 6.9% and Minnesota at 7.7%.

The difference between West Virginia and Maryland is substantial. Premiums account for 21.6% of median household income in West Virginia compared with 5.6% in Maryland.

States where premiums take the smallest share of income

Several states with the lowest insurance burden also have some of the highest median household incomes.

Massachusetts has the highest median household income in the dataset at $104,828, while New Jersey records $104,294 and Maryland $102,905.

This does not mean these states necessarily have the lowest premiums. Massachusetts, for example, has an average annual premium of $8,700. Instead, the figures show how premium costs compare with household earnings.

Arkansas sees the biggest annual increase

The current cost of premiums is only part of the picture. The analysis also compared 2026 premiums with the previous year to identify where costs have increased most sharply.

Arkansas recorded the largest annual increase, with average monthly premiums rising by 67%.

The state now has an average monthly premium of $823, equivalent to $9,876 per year. With median household income at $62,106, premiums account for 15.9% of household income.

Mississippi recorded the second-largest increase at 42%, followed by Washington at 40% and Tennessee at 39%.

Texas saw a 35% increase, while Nevada recorded a 34% rise and Florida increased by 33%.

States with the biggest annual increases in premiums

The increases are not uniform across the country. Alaska is the only state in the dataset to record a decrease, with average monthly premiums falling by 5% from the previous year.

New York and Oregon recorded relatively small increases of 5%, while Vermont increased by 6% and South Dakota by 6%.

Texas has the highest uninsured rate

The analysis also shows substantial differences in the percentage of residents without health insurance coverage.

Texas has the highest uninsured rate in the dataset, with 16.7% of residents without health insurance coverage.

The state has a population of more than 29 million and an average monthly health insurance premium of $826. Its median household income is $79,721, putting annual premiums at 12.4% of household income.

Oklahoma has the second-highest uninsured rate at 11.5%, followed by Nevada at 11.4%, Alaska at 11% and Florida at 10.9%.

States with the highest uninsured rates

The states with the lowest uninsured rates include Massachusetts at 2.8%, Hawaii at 3.5%, Vermont at 4.2%, New Hampshire at 4.5% and New York at 5%.

The uninsured rate and premium burden measure different aspects of healthcare coverage, so a state with a lower uninsured rate does not necessarily have lower insurance costs.

What the data tells us about health insurance costs

The figures demonstrate considerable variation in health insurance costs across the US.
Vermont has the highest average annual premium at $14,688, but West Virginia has the highest premium-to-income ratio because its median household income is substantially lower.

Arkansas provides another example of how quickly the picture can change. Its average premium increased by 67% in a single year, the largest increase recorded in the dataset.

Texas combines the highest uninsured rate with a 35% annual increase in average premiums. Its 12.4% premium-to-income ratio, however, places it outside the top 10 states for insurance burden.

Looking at premium costs alongside household income, annual changes and insurance coverage provides a broader picture of how health insurance costs differ across the country.

Methodology

We analyzed data for all 50 US states, excluding Washington, D.C., to compare annual health insurance premiums with median household income.

Health insurance premium figures are based on Silver plans for a 40-year-old under the Affordable Care Act (ACA), the most commonly selected plan tier, which balances monthly premiums with out-of-pocket costs. Annual insurance costs were calculated by multiplying the average monthly premium by 12.

The ranking was then calculated by dividing each state's annual health insurance premium by its median household income and multiplying by 100 to determine the percentage of household income represented by health insurance premiums.

All other data was collected from the United States Census Bureau and analyzed by our team. The dataset also includes each state's uninsured population rate, total population, and annual change in average monthly health insurance premiums compared with the previous year.

Actual insurance costs and the amount paid by individual households can vary depending on factors including age, location, household circumstances, plan choice, and eligibility for financial assistance.

Calculation:

Annual health insurance premium ÷ median household income × 100 = percentage of income represented by health insurance premiums