Health care prices vary dramatically within the United States, and the same goes for insurance premiums. The Affordable Care Act (ACA) was somewhat helpful in lowering health care spending and reducing the uninsured rate, but the health reform law has serious limitations. Despite its name, the ACA didn’t bring the most affordable health plans to every region in the U.S. The Kaiser Family Foundation measured premiums for mid-level health plans offered on the government exchanges, and identified the most expensive regions in America for health insurance in 2015.
For those who don’t have health insurance through an employer, the health marketplace offers bronze, silver, gold, and platinum options. The silver plans are the ones most consumers buy and cover roughly 70% of medical expenses. In its analysis, the Kaiser Family Foundation looked at monthly premiums for the lowest-cost silver plan available. Prices were estimated for a hypothetical 40-year-old patient, but in most cases, the areas with the highest and lowest premiums stay the same regardless of age. (Nearly every state charges higher premiums for the elderly.) Of course, the following prices aren’t always what the patient ends up paying, as the government subsidizes premiums for low- and middle-income people.
The price differences across comparable health insurance plans are staggering, nonetheless. Premiums in the most expensive areas are triple those in the least expensive areas. Katherine Hempstead, a researcher for the Robert Wood Johnson Foundation, told NPR she found no significant differences in the designs of the plans that would explain their premiums. “In most of the plans — cheap or expensive — there seemed to be a high deductible and fairly similar cost-sharing,” she explained.
The national median premium for a 40-year-old is $269, according to the Kaiser Foundation. Last year, southwestern Georgia was among the most expensive markets despite the low cost of living. No regions in Georgia were on the 2015 list, but the Kaiser Foundation continued to see many rural, low-income areas carrying the burden of the highest health insurance premiums in the country. 2015 marks the second year of operation for the health insurance marketplace, and while 2014’s list saw Colorado ski resort towns and Fairfield, Connecticut, an affluent New York City suburb, among the priciest places, this year’s list is made up of even more rural, low-income, or sparsely populated areas.
Long distances between providers and patients also adds to the costs, according to Ceci Connolly, director of PwC’s Health Research Institute, and restraining prices in America’s rural communities “continues to be a challenge.” When there are fewer doctors and hospitals, for example, the ones that are there have the power to dictate higher prices. In other words, the places in the U.S. where people could use the most help are often the ones where the market is lacking meaningful competition, driving prices higher. For the patients who live in these regions, this can mean serious financial challenges when it comes to getting coverage. Here are the areas of the U.S. with the most costly health insurance premiums for 2015.
10. Cheyenne, Wyoming ($401)
Wyoming’s capitol city and the rest of Laramie County rank tenth in terms of insurance rates. Last year, “most of Wyoming” was ranked fifth, excluding Natrona and Laramie counties, with a premium of $405. But this year, the state of Wyoming is broken up and appears on the list three times.
9. Inland California ($410)
Inyo and Mono counties, on the eastern border of California, and Imperial County, on the southern border with Mexico, collectively rank ninth. They are the most expensive markets for health insurance in the state. California did not appear on the 2014 list.
8. Casper, Wyoming ($412)
Casper, Wyoming, the state’s second largest city, and the rest of Natrona County rank eighth with a premium of $412. Wyoming is one of the least densely populated states in America, second only to Alaska.
7. Rural Nevada ($418)
Coming in at the No. 7 spot, rural Nevada includes the counties of Churchill, Elko, Eureka, Humboldt, Lander, Mineral, Pershing, and White Pine. Rural Nevada was ranked third last year, with its cheapest plan costing $456.
6. Vermont ($428)
The entire state of Vermont ranks sixth, up from eighth in 2014, in terms of monthly premiums for a 40-year-old patient. However, it should be noted that Vermont and New York are the only states that do not allow insurers to charge older people higher premiums. Thus, depending on the age of the patient, Vermont’s rank changes. For young adults, insurance costs will be higher than other areas, but for those nearing 65 they will be lower.
5. Rural Wyoming ($440)
Rural Wyoming, coming in at fifth, includes the counties of Albany, Big Horn, Campbell, Carbon, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Lincoln, Niobrara, Park, Platte, Sheridan, Sublette, Sweetwater, Teton, Uinta, Washakie, and Weston.
4. Plattsburgh, New York ($446)
Clinton County, home of the city of Plattsburgh, is one of two New York regions on the list. Plattsburgh is near the Canadian border on the east side of the state, just an hour’s drive from Montreal. This region has the fourth most expensive insurance premiums.
3. Bay St. Louis, Mississippi ($456)
Hancock County and Bay St. Louis, Mississippi come in at third, breaking the $450 mark. Bay St. Louis is just an hour’s drive from New Orleans and is one of the many Gulf Coast cities devastated by Hurricane Katrina in 2005. Southeast Mississippi was ranked seventh last year, when Hancock County’s cheapest plan was $447.
2. Ithaca, New York ($459)
Ithaca, New York and Tompkins County make up the second most expensive region in the nation. Ithaca is home of Cornell University, and the city also has a community-based health care cooperative called Ithaca Health Alliance, which was founded in 1997 and operates a free clinic to support the uninsured and underinsured.
1. Alaska ($488)
The state of Alaska is home to the country’s most expensive health insurance premiums for silver plans. Premiums in this state rose 28% since 2014, taking it from tenth place on last year’s list all the way up to first. Just two insurers offer plans in the state, the same number as last year, according to researchers. Prices are also high in Alaska because of the state’s high cost of living, driving up the salaries of medical professionals.