Where Obamacare plans cost the most in 2021

From 2020 to 2021, average monthly premiums decreased in 24 states and increased in another 24 states.

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Derek SilvaSenior Editor & Personal Finance ExpertDerek is a former senior editor and personal finance expert at Policygenius, where he specialized in financial data, taxes, estate planning, and investing. Previously, he was a staff writer at SmartAsset.

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The Affordable Care Act, also called Obamacare or the ACA, guarantees basic health coverage and allows U.S. residents to buy a health insurance plan through either the federal health insurance marketplace or through their state’s own marketplace. For 2021 plans that people purchased at the end of 2020, 36 states used the federal marketplace and 15 states (including the District of Columbia) ran their own state-based exchanges (SBEs).

To get a picture of how health insurance consumers were faring in the age of the coronavirus pandemic, we looked at how each state handles coverage on the Obamacare exchange: how many people are enrolled in a marketplace plan, how much premiums cost in 2021, and how much each state offers in tax credits to make health insurance more affordable.

Overall enrollment in Obamacare plans increased from 11.4 million in 2020 to 12 million in 2021, the first time Obamacare enrollment has increased since 2015 and the first time at least 12 million people bought an exchange plan since the 2016 open enrollment period. Half of all Obamacare enrollments for 2021 came from five states, with the top three states — Florida, California, and Texas — combining for 42% of all signups. Across the country, average premiums decreased by $9 for 2021, with half of states seeing an overall increase and the other half seeing a decrease. And while 2021 premiums range from $400 to $1,000 depending on the state, that doesn’t factor in health insurance subsidies. The advance premium tax credit (APTC) could bring average 2021 premiums to less than $75 in some states.

Key takeaways

  • Enrollment in Obamacare plans increased to $12 million for 2021, the first increase since 2015 open enrollment

  • Florida, California, and Texas accounted for 42% of all ACA enrollees during 2021 open enrollment

  • Average monthly premiums fell in 24 states from 2020 to 2021 — to an average of $37 — and increased in 24 states — to an average of $19

  • Most ACA enrollees receive the advance premium tax credit (APTC), which helps low-income individuals afford insurance by decreasing monthly premiums to as little as 7% of their pre-APTC cost in some states

How many people enrolled in an Obamacare plan for 2021?

More than 12 million people selected health insurance plans through Obamacare during the 2021 open enrollment period, which lasted from Nov. 1, 2020, to Dec. 15, 2020, in most states. The increase in enrollment (compared to about 11.4 million for both 2020 and 2019) is notable because Obamacare enrollment had been decreasing every year since President Trump took office and worked to roll back parts of Obamacare. (For example, open enrollment was shortened by two weeks in 2017 and the Trump administration repealed the individual mandate in 2019.) Of the people who bought a marketplace plan for 2021, 79% had also purchased a marketplace plan from the same state for 2020, while 21% were new customers.

Obamacare enrollment by year

Year

ACA enrollment

2014

8.0 million

2015

11.7 million

2016

12.7 million

2017

12.2 million

2018

11.8 million

2019

11.4 million

2020

11.4 million

2021

12.0 million

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How COVID-19 affected Obamacare plans in 2021

The increase in Obamacare enrollment for 2021 is likely the result of Americans losing their jobs because of COVID-19. Department of Labor statistics show more than 10 million people were receiving unemployment benefits before open enrollment. A majority of people in the U.S. get health insurance from their jobs, so losing a job during the pandemic means losing health coverage. Some people may have kept their previous employer’s insurance through COBRA coverage, but COBRA is unaffordable for most Americans.

Even for people who didn’t completely lose their jobs, buying a marketplace plan may have been necessary. Many people enroll in ACA plans because they do not have access to affordable health insurance, a situation made worse during the pandemic. Workers who didn’t completely lose their jobs still had their hours reduced. Others may have transitioned from full-time work to contractor positions in the gig economy. Then of course there are the millions of people who missed work or incurred medical bills because they or someone they knew had COVID-19.

Increased plan enrollment is also interesting because, for years, the percentage of the population that had health insurance was decreasing. Not only did Obamacare enrollment decrease from 2016 to 2020, but Census data shows the overall number of uninsured Americans also increased from 7.9% in 2017 to 8.5% in 2018 and then to 9.2% in 2019. Perhaps the uptick in 2021 ACA plans is a sign that America is working to reverse its current trajectory and more Americans will get insurance going forward.

Related article:Health insurers aren’t covering all COVID-related hospitalizations anymore

States with the most & least Obamacare enrollees in 2021

During 2021 open enrollment, 36 states used the federal government’s marketplace, healthcare.gov, and 15 states, including the District of Columbia, ran their own state-based exchanges. The federal marketplace accounted for 69% of 2021 ACA enrollments and the state exchanges accounted for 31% of enrollments.

Three states accounted for 42% of all ACA enrollees in 2021: Florida, California, and Texas. Rounding out the top five states using Obamacare plans are North Carolina and Georgia. These five states have 51% of all enrollees. (California is the only state in the top five that runs an SBE.)

The 5 states with the most Obamacare enrollees

Florida, which uses the federal marketplace, had the most ACA enrollees in 2021 — 2.1 million people — and accounted for 18% of all ACA enrollees. The number of enrollees in Florida increased 11% from 2020 (205,375 more people in 2021 than 2020). Based on the Census Bureau’s latest population estimates for Florida, 10% of Florida’s population enrolled in a marketplace plan for 2021.

California had about 1.6 million people enroll through its state exchange in 2021 and accounted for about 14% of all ACA enrollees. The number of enrollees increased 6% from 2020 to 2021.

Texas, using the federal exchange, had about 1.3 million people enroll for a health insurance plan in 2021. That enrollment is 11% of the national ACA enrollment, and Texas saw an increase of 16% from 2020 (175,679 more people in 2021).

North Carolina had the fourth most Obamacare enrollments for 2021 at 536,000, accounting for almost 5% of the country’s total enrollments. The state saw signups increase 6% from 2020, making it one of the biggest users of the federal marketplace.

Georgia saw about 517,000 residents sign up for an ACA plan, also through the federal marketplace. The state’s enrollment was equal to about 4% of national enrollments and represented a nearly 12% increase from Georgia’s 2020 signups.

The 5 states with the fewest Obamacare enrollees

Based on the states where the fewest number of people purchased ACA plans for 2021, here are the five states that use Obamacare the least, accounting for just 0.8% of all ACA enrollees:

  • District of Columbia: 16,947 ACA enrollees (3% decrease vs. 2020)

  • Alaska: 18,184 ACA enrollees (3% increase vs. 2020)

  • West Virginia: 19,391 ACA enrollees (3% decrease vs. 2020)

  • North Dakota: 22,709 ACA enrollees (5% increase vs. 2020)

  • Hawaii: 22,903 ACA enrollees (14% increase vs. 2020) 

However, if you control for population, by looking at the number of plans purchased as a percentage of a state’s population, the list changes. Here are the five states with the fewest ACA enrollees, as a percentage of state population:

  • New York: 1.1% of state population

  • West Virginia: 1.1% of state population

  • Hawaii: 1.6% of state population

  • Kentucky: 1.7% of state population

  • Ohio: 1.7% of population

The cost of an Obamacare plan in 2021

The cost of health insurance plans varies by state, with Vermont having the highest average premium in 2021 at $1,050 and Utah having the lowest average monthly premium at $405. Across the country, 24 states saw their average premiums decrease from 2020 to 2021 and 24 states had higher average premiums in 2021. In the states with lower premiums in 2021, the average premium was $37 lower. Across states with higher premiums in 2021, the premiums rose just $19. (Note that premium data was not available for Idaho or Nevada.)

States where premiums increased the most

Here are five states that saw Obamacare premiums increase the most in 2021:

  • Louisiana: +$64

  • West Virginia: +$46

  • Indiana: +$39

  • Alabama: +$38

  • Massachusetts: +$37

States where premiums decreased the most

Here are five states that saw Obamacare premiums decrease the most in 2021:

  • Iowa: -$167

  • Wyoming: -$97

  • Maine: -$84

  • New Hampshire: -$83

  • Maryland: -$59

State*

Average 2021 premium

Change from 2020

Alabama

$729

+$38

Alaska

$697

-$42

Arizona

$581

-$8

Arkansas

$546

+$24

California

$571

+$2

Colorado

$459

-$19

Connecticut

$692

+$8

Delaware

$675

+$7

District of Columbia

$541

+$7

Florida

$599

+$2

Georgia

$583

+$17

Hawaii

$624

-$8

Illinois

$625

-$11

Indiana

$583

+$39

Iowa

$656

-$167

Kansas

$628

-$10

Kentucky

$605

+$11

Louisiana

$741

+$64

Maine

$558

-$84

Maryland

$439

-$59

Massachusetts

$435

+$37

Michigan

$480

$0

Minnesota

$439

-$5

Mississippi

$622

+$14

Missouri

$639

+$5

Montana

$571

-$1

Nebraska

$722

-$43

New Hampshire

$446

-$83

New Jersey

$575

+$21

New Mexico

$463

-$13

New York

$656

+$13

North Carolina

$633

-$27

North Dakota

$485

+$32

Ohio

$524

+$2

Oklahoma

$623

-$21

Oregon

$562

+$4

Pennsylvania

$622

-$26

Rhode Island

$455

+$20

South Carolina

$583

-$30

South Dakota

$698

+$11

Tennessee

$619

-$22

Texas

$550

+$18

Utah

$405

-$20

Vermont

$1,050

+$16

Virginia

$595

-$46

Washington

$505

-$23

West Virginia

$1,038

+$46

Wisconsin

629

-$28

Wyoming

870

-$97

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*Data does not include Idaho or Nevada because premium data wasn’t available.

Obamacare premiums by metal tier

Marketplace prices also vary based on the metal tier of your plan. The four metal tiers of the Affordable Care Act — bronze, silver, gold, platinum — are based on the average amount of health care expenses that a customer would have to pay versus how much the insurer would pay.

Bronze plans often have low premiums, but you pay more out of pocket if you incur medical expenses. Platinum plans, which aren’t available in all areas, have the highest monthly premiums on average, but your insurer would cover more of your potential medical expenses. There are also catastrophic health plans, which usually have the lowest monthly premiums because they cover little (if anything) beyond the essential health benefits.

Obamacare enrollment by age & metal tier in 2021

Age

Bronze

Silver

Gold

17 or younger

357,404

321,867

80,720

18 to 25

271,782

510,120

40,889

26 to 34

451,380

676,200

82,295

35 to 44

480,218

768,983

90,797

45 to 54

565,016

959,589

99,670

55 to 64

875,286

1,266,573

155,956

65 or older

28,594

97,255

3,573

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Average monthly ACA premiums by metal tier

Silver plans are the most popular nationally. However, silver plans are only the most popular in about half of all states. Bronze plans were most popular in most other states.

In general, silver plans aren’t the cheapest but they’re the only ones that allow people to receive premium subsidies (explained more in the next section). Most ACA enrollees do receive a subsidy. For anyone who doesn’t qualify for a subsidy, a bronze plan will usually offer the lowest premium. Gold plans are usually the most expensive of these three tiers (though platinum plans are the most expensive overall), and they are also the last popular of the three in most states. 

The table below includes data for the 36 states that used the federal ACA exchange in 2021. The 15 states that used state-based exchanges (including the District of Columbia) have different reporting requirements and weren’t included in this table. Platinum plans and catastrophic plans were also omitted because they aren’t available in all counties or states.

The cost of Obamacare plans after subsidies

People who have a difficult time affording health insurance may qualify for a health insurance subsidy. The most common type of subsidy is the advance premium tax credit (APTC), which functions as a tax credit that you can take throughout the year to lower your monthly premiums. Someone can only claim the APTC if they purchase a silver plan.

In all states — but not in the District of Columbia — the majority of people who enroll in an ACA plan also receive the APTC. However, the value of the APTC varies widely by state, based on two things: the premium of the second-lowest cost silver plan (SLCSP) on the market and the income of the enrollee. The exact premium of a state’s SLCSP depends on the plans available in that state, and Obamacare rules explain that individuals only have to pay a final premium that’s worth a specific percentage of their annual income. For example, a state may decide someone with an income of $35,000 shouldn’t be spending any more than 8% of their income on insurance premiums.

The APTC is generally available for people who have an income within 100% and 400% of the federal poverty level. Individuals with incomes below that level can usually get Medicaid instead. In the table below, you can see the percentage of ACA enrollees in each state that receive the APTC, how much they receive, and the average premium across all enrollees based on the final amount that APTC recipients pay.  

States that use the APTC most in 2021

State

Percent of ACA enrollees with APTC

Average premium with APTC

Average final premiums across all enrollees

Alabama

90.4%

$73

$122

Alaska

79.3%

$91

$197

Arizona

77.5%

$130

$219

Arkansas

85.2%

$135

$187

California

87.1%

$146

$187

Colorado

68.2%

$152

$228

Connecticut

69.1%

$87

$241

Delaware

81.1%

$119

$211

District of Columbia

7.0%

$206

$508

Florida

93.9%

$73

$104

Georgia

87.6%

$81

$136

Hawaii

79.8%

$114

$191

Idaho

78.0%

*

*

Illinois

81.4%

$178

$244

Indiana

70.4%

$172

$281

Iowa

85.0%

$102

$168

Kansas

85.8%

$116

$180

Kentucky

79.5%

$119

$199

Louisiana

87.8%

$126

$189

Maine

80.7%

$120

$187

Maryland

73.3%

$100

$182

Massachusetts

72.9%

$150

$228

Michigan

81.0%

$143

$192

Minnesota

49.7%

$275

$302

Mississippi

94.3%

$81

$110

Missouri

84.4%

$102

$172

Montana

80.0%

$120

$196

Nebraska

92.8%

$54

$95

Nevada

84.8%

*

*

New Hampshire

64.0%

$148

$236

New Jersey

79.0%

$163

$228

New Mexico

72.3%

$117

$195

New York

51.9%

*

$256

North Carolina

89.6%

$82

$125

North Dakota

83.3%

$84

$135

Ohio

74.1%

$163

$243

Oklahoma

91.0%

$61

$106

Oregon

70.0%

$150

$246

Pennsylvania

85.1%

$131

$184

Rhode Island

79.3%

$120

$175

South Carolina

89.5%

$85

$128

South Dakota

90.7%

$89

$132

Tennessee

85.8%

$101

$162

Texas

89.7%

$78

$120

Utah

89.9%

$62

$91

Vermont

80.0%

$294

$461

Virginia

83.5%

$100

$171

Washington

60.7%

$134

$262

West Virginia

85.7%

$221

$323

Wisconsin

83.3%

$118

$185

Wyoming

90.6%

$60

$127

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*Data unavailable

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