Health Insurance
Where Families Pay the Most for Health Insurance
Americans with employer-based health insurance pay an average of nearly $6,000 a year for family premiums, according to the Kaiser Family Foundation (KFF).
The latest ValuePenguin study analyzes KFF data to reveal where families pay the most for health insurance relative to the national average. The research not only spotlights the states in which families pay the most, but also where costs have been rising the fastest over the past year and past five years.
Florida tops the list for a family’s share of total health insurance premium expenses, followed by the District of Columbia and Mississippi.
- Key findings
- Florida families pay the most for health insurance
- Washington state families pay the least for health insurance
- Full rankings: Where families pay the most for health insurance
- Nevada families saw the biggest jump in premiums between 2019 and 2020
- Kansas families saw the biggest 5-year jump in premiums
- Drug, medical care costs contribute to higher premiums
- Methodology
Key findings
-
Florida families pay the most for health insurance. Workers in the Sunshine State pay an average of $7,674 a year for family premiums — that’s 28.4% more than the national average of $5,978. Families in the District of Columbia and Mississippi follow closely, paying family premiums of $7,445 and $7,421, respectively.
- Washington state families pay the least for health insurance. Workers in the Evergreen State pay an average of $4,610 a year for family premiums — 22.9% less than the national average. Families in Indiana ($4,769) and Michigan ($4,842) pay similar family premiums.
- Nevada families saw the biggest jump in premiums between 2019 and 2020. Workers in the Silver State saw average family premiums rise from $5,087 to $7,285 in this period — an increase of 43.2%. Families in Indiana saw the biggest decrease in premiums from 2019 to 2020 — $5,624 to $4,769, or down 15.2%.
- Kansas families saw the biggest five-year jump in premiums. Workers in the Sunflower State saw average family premiums rise from $4,669 in 2016 to $7,253 in 2020 — an increase of 55.3%. Washington state saw the biggest decrease in the same period — from $5,028 to $4,610, or down 8.3%.
Florida families pay the most for health insurance
Florida families pay higher premiums than those in any other state in the U.S., at an average of $7,674, according to 2020 figures. Employer contributions to plans in Florida rank ninth-lowest in the U.S. by dollar amount, which contributes to the high premiums.
Sunshine State workers are also paying the third-highest percentage of employee contributions, on average, across the U.S. They’re kicking in more than a third, or 37%, of the total premiums — higher than the average employee contribution in the U.S. of 29%.
In Florida, employers pay only 63% toward employee health insurance premiums, compared with the national average of 71%. This leaves a higher percentage for Florida employees with families to pay. However, Florida’s total average annual family health insurance premiums of $20,862 are pretty middle of the pack, ranked 21st among total premiums.
Closer look: Family premiums in Florida | |||
|---|---|---|---|
| Florida | U.S. | Florida rank in U.S. | |
| Employee contribution ($) | $7,674 | $5,978 | 1 |
| Employer contribution ($) | $13,188 | $14,780 | 43 |
| Total annual premium ($) | $20,862 | $20,758 | 21 |
| Employee contribution (%) | 37% | 29% | 3 |
| Employer contribution (%) | 63% | 71% | 48 |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
The District of Columbia’s annual family premiums are only a couple hundred dollars less than Florida’s, followed by Mississippi's. Families in the District of Columbia and Mississippi pay at least 24% more for premiums than the national average. The average employer contribution in the nation's capital is $15,057, higher than average by dollar amount. But when ranked as a percentage of total premiums, it’s near the bottom (11th-lowest).
Mississippi, which doesn’t share the same geography or demographics as the District of Columbia, nevertheless has its families paying a similarly high annual family premium of $7,421. The employer contribution in this southern state is the lowest-ranking of all at 61%. However, its average total annual premium — paid by both employer and employee together — is less than the national average, coming in at $19,058.
Here’s a look at the five states where families pay the most for health insurance:
Where families pay the most for health insurance: 2020 | |||
|---|---|---|---|
| Rank | State | Average annual family premium | Percentage change from national average |
| 1 | Florida | $7,674 | 28.4% |
| 2 | District of Columbia | $7,445 | 24.5% |
| 3 | Mississippi | $7,421 | 24.1% |
| 4 | Nevada | $7,285 | 21.9% |
| 5 | Kansas | $7,253 | 21.3% |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
Washington state families pay the least for health insurance
In the other Washington — the state on the West Coast — families contribute the lowest amount by dollars to their annual premium, chipping in $4,610 annually, 22.9% below the national average of nearly $6,000.
Closer look: Family premiums in Washington state | |||
|---|---|---|---|
| Washington state | U.S. | Washington state rank in U.S. | |
| Employee contribution ($) | $4,610 | $5,978 | 51 |
| Employer contribution ($) | $14,866 | $14,780 | 22 |
| Total annual premium ($) | $19,476 | $20,758 | 43 |
| Employee contribution (%) | 24% | 29% | 49 |
| Employer contribution (%) | 76% | 71% | 5 |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
Indiana families follow with the second-lowest payments into their annual premiums. Indiana families pay an annual average premium of $4,769, while Michigan families pay less than $100 more than their Midwestern neighbors, or $4,842 a year.
Of interest, the annual average premium paid by employers in Michigan is very close to what is paid in the District of Columbia — $15,166 in Michigan, versus $15,057 in the nation’s capital city. However, the total cost of health care premiums in D.C. is about $2,500 more a year than in the Wolverine State.
Arkansas companies in 2020 paid the lowest premiums by dollar amount for their employees — $11,300 on average — but Arkansas’ average full premiums, both employee and employer combined, are also the lowest at $17,093 a year. Overall, the southern state checked in just outside the top 20 states where families pay the least for health insurance.
Here’s a look at the five states where families pay the least for health insurance:
Where families pay the least for health insurance: 2020 | |||
|---|---|---|---|
| Rank | State | Average annual family premium | Percentage change from national average |
| 1 | Washington | $4,610 | -22.9% |
| 2 | Indiana | $4,769 | -20.2% |
| 3 | Michigan | $4,842 | -19.0% |
| 4 | Ohio | $4,906 | -17.9% |
| 5 | Tennessee | $5,186 | -13.2% |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
Full rankings: Where families pay the most for health insurance
Where families pay the most/least for health insurance: 2020 | |||
|---|---|---|---|
| Rank | State | Average annual family premium | Percentage change from national average |
| 1 | Florida | $7,674 | 28.4% |
| 2 | District of Columbia | $7,445 | 24.5% |
| 3 | Mississippi | $7,421 | 24.1% |
| 4 | Nevada | $7,285 | 21.9% |
| 5 | Kansas | $7,253 | 21.3% |
| 6 | South Carolina | $7,206 | 20.5% |
| 7 | Louisiana | $7,104 | 18.8% |
| 8 | Missouri | $7,072 | 18.3% |
| 9 | Texas | $6,950 | 16.3% |
| 10 | New Jersey | $6,927 | 15.9% |
| 11 | Delaware | $6,852 | 14.6% |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
Nevada families saw the biggest jump in premiums between 2019 and 2020
While most states experienced rising annual premiums for their employer-sponsored health insurance, according to the ValuePenguin analysis, the state with the highest jump was Nevada.
Nevada families were struck with a 43.2% increase in annual premiums between 2019 and 2020, raising their cost to an average of $7,285. Of note: In 2016, Nevada families were paying $2 more in premiums on average — $5,089 — than they were in 2019 — $5,087.
The reason might be correlated to Nevada employers’ contribution to the average family premium. Workers in the state only had 63% of their premiums covered by employers in 2020 — a 10 percentage point drop from 73% in 2019. In dollar costs, employers in 2020 paid an average of $12,239 in Nevada, the fifth-lowest amount in the nation. The U.S. average is $14,780.
Idaho families’ annual premiums increased 40.3%, the second-highest year-over-year spike. Families contributed an average annual premium of $6,019 in 2020, slightly above the national average, versus $4,290 in 2019. Idaho saw a similar change to Nevada: Employer contributions in 2020 equaled 72% — a six percentage point drop from 2019.
Where families pay the most/least for health insurance: 2019 to 2020 | ||||
|---|---|---|---|---|
| Rank | State | Average annual family premium, 2019 | Average annual family premium, 2020 | Percentage change |
| 1 | Nevada | $5,087 | $7,285 | 43.2% |
| 2 | Idaho | $4,290 | $6,019 | 40.3% |
| 3 | Michigan | $3,685 | $4,842 | 31.4% |
| 4 | Kansas | $5,654 | $7,253 | 28.3% |
| 5 | New Jersey | $5,435 | $6,927 | 27.5% |
| 6 | Mississippi | $5,929 | $7,421 | 25.2% |
| 7 | Alaska | $4,718 | $5,905 | 25.2% |
| 8 | District of Columbia | $6,014 | $7,445 | 23.8% |
| 9 | Iowa | $5,259 | $6,417 | 22.0% |
| 10 | Vermont | $4,862 | $5,784 | 19.0% |
| 11 | Oregon | $5,404 | $6,124 | 13.3% |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
Kansas families saw the biggest 5-year jump in premiums
Kansas families experienced the largest five-year jump in their contribution to premiums in the 2016-to-2020 period, with costs going up 55.3% to $7,253, well above the national average. In 2020, employer contributions to family premiums in the state covered 64% — a substantial drop from 72% in 2016. (As a reminder, employees chip in the rest.)
Where families pay the most/least for health insurance: 2016 to 2020 | ||||
|---|---|---|---|---|
| Rank | State | Average annual family premium, 2016 | Average annual family premium, 2020 | Percentage change |
| 1 | Kansas | $4,669 | $7,253 | 55.3% |
| 2 | Iowa | $4,306 | $6,417 | 49.0% |
| 3 | Oregon | $4,200 | $6,124 | 45.8% |
| 4 | South Carolina | $5,007 | $7,206 | 43.9% |
| 5 | Nevada | $5,089 | $7,285 | 43.2% |
| 6 | Michigan | $3,439 | $4,842 | 40.8% |
| 7 | Mississippi | $5,408 | $7,421 | 37.2% |
| 8 | Wisconsin | $3,817 | $5,220 | 36.8% |
| 9 | District of Columbia | $5,476 | $7,445 | 36.0% |
| 10 | North Dakota | $4,536 | $6,003 | 32.3% |
| 11 | Maine | $4,699 | $6,209 | 32.1% |
Source: ValuePenguin analysis of Kaiser Family Foundation data.
Washington state families, on the other hand, saw their annual premiums drop 8.3% in the same time frame, from $5,028 to $4,610. The only other state where premiums dropped from 2016 to 2020 was Montana, where annual premiums fell 2.5%, from $5,570 to $5,430.
Drug, medical care costs contribute to higher premiums
The Commonwealth Fund — a New York-based foundation that supports health research — notes in a January 2022 study on state trends on employer premiums and deductibles that the cost to insure has risen because spending per person has gone up among employer-sponsored plans. It’s not that the individuals are seeking more care more often, but that the prices charged by drug companies and health care providers have spiked.
Southern states tend to have workers contributing the most to their plans when factoring in median income, Sara Collins — The Commonwealth Fund vice president for health care coverage and access — told the U.S. Senate Committee on Finance in October 2021. The testimony noted this to be the case in Alabama, Arkansas, Delaware, Florida, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina and Texas. (Not-so-southern states Nevada and New Mexico were included.)
One reason for this, according to the initial January 2022 Commonwealth Fund study, is that firms that pay lower average wages had their workers paying a higher share of their total family health insurance costs than those employers with higher-than-average wages.
Despite extra costs associated with family plans, it’s not necessarily the case that families are paying more than they would if they were single, or being crushed more than single households under the cost of their premiums. In fact, overall, they may be paying less per individual. Data from the U.S. Bureau of Labor Statistics’ 2020 Consumer Expenditure Survey shows that the average married couple with children spends 4.04% of their income on health insurance, compared with 4.86% for single households.
Independent of employer-based health insurance: The annual cost of health insurance for a 40-year-old individual on a Silver plan under the Affordable Care Act is $6,487. If you live in West Virginia, expect that cost to balloon to almost $10,000 annually for the same individual. On the least-costly end of the scale is Georgia, where the annual Silver plan premiums average just $3,708.
Expansion of telehealth, mental health services could be future factor
A November 2021 survey on the rise of average family premiums from KFF found that large employers’ telehealth and mental health services were heavily expanded amid the pandemic. In fact, almost two-thirds — or 65% — of firms with at least 50 workers offering health plans say they made changes related to telemedicine amid the pandemic.
Meanwhile, researchers expect premium costs to continue to climb in 2022, perhaps rising 5%, according to an October 2021 study from Willis Towers Watson — a global advisory firm based in Arlington, Va. The rise would be more than double the 2.1% increase in 2020, which was impacted by the pandemic’s smaller in-person health facility utilization.
Methodology
ValuePenguin researchers analyzed Kaiser Family Foundation (KFF) data on average annual premiums on a per-employee basis for families with employer-based health insurance in each state and the District of Columbia.
States were ranked from high to low by average family premiums in 2020. Researchers also analyzed the KFF data for 2019 and 2016 to make one-year and five-year comparisons.