If you plan to buy health insurance through the Affordable Care Act exchanges for next year, you can now get a pretty good idea of how much it’ll cost you. That's because insurers have unveiled their initial proposals for 2019 premiums in each state. (Roll over the map below to see what's happening where you live.) The rates will be finalized in the coming weeks before open enrollment for plans sold on the ACA exchanges begins Nov. 1. Premiums are still high, but most insurers aren’t hiking rates as sharply as they did the past few years. Some insurers are even lowering premiums. Deductibles remain steep, too, depending on which plan you choose. But what you end up paying will vary dramatically based on where you live and what your state is doing—or not doing—to support insurance markets.

ACA Health Insurance Costs
Average costs vary widely across the U.S.  Roll over your state to see 2019 premiums.


2019 Average Monthly Premiums
$300
$900

The Trump administration, in fact, has made it clear that it wants states to have more control over their own health insurance markets.

For the first time since the ACA was implemented in 2014, there is no federal requirement for people to buy health insurance or pay a penalty. But several states are imposing their own mandate requiring residents to buy health insurance.

The federal government also has loosened regulations to allow states to offer cheaper health insurance that doesn’t have all the requirements of ACA plans. Yet more than a dozen states either have laws on the books or are passing new regulations to limit the availability of those non-ACA plans.

There is one area of consensus among states on a way to bring down the high cost of insurance for people who don’t get financial subsidies: reinsurance programs.

The Department of Health and Human Services is clearing the way for more states to create reinsurance programs, partially funded by the federal government, to reimburse insurers who cover high-cost claims. In the states that have reinsurance programs up and running or planned for 2019, insurers say getting compensated for covering people with costly medical bills helps curtail premium increases.

One note on the map above: The average monthly premium in each state is based on the second-lowest-cost Silver plan for a 40-year-old nonsmoker (benchmark plan) who doesn't receive financial subsidies. Your own premium will vary depending on your age, financial status and which plan you choose.


Sources: Insurer rate filings, Centers for Medicare & Medicaid Services, Kaiser Family Foundation, Commonwealth Fund, Urban Institute.
Last updated: August 15, 2018