Key findings
- Across the 15 states in this index, the median lowest-cost Silver premium for a 40-year-old ranges from $558/month in Indiana to $875/month in Nebraska — a 57% difference for the same metal tier.
- 5 states have no PPO plans at all on the 2026 marketplace: Indiana, Kansas, Ohio, Texas, Utah. Every plan is an HMO, EPO or POS, which limits out-of-area care — a material constraint for self-employed people who travel for work.
- 4 states have no HMO plans: Alabama, Arkansas, Kansas, Nebraska. Kansas is the narrowest market in the index — EPO only, statewide.
- 36 of 1,314 counties (2.7%) have only one marketplace carrier, concentrated in Kansas (14), Alabama (7), Texas (7).
- Florida has the widest in-state spread: Silver at 40 runs $554 to $2,203 depending on county — a 4.0× difference within a single state.
- Premiums roughly 2.2× to 2.6× between age 27 and age 60, before subsidies.
State-by-state, cheapest to most expensive
Lowest-cost Silver plan premiums, full price before any premium tax credit. Sorted by median.
| State | Median @40 | Range @40 | Low @27 | Low @60 | Carriers | Counties | 1-carrier | Plan types |
|---|---|---|---|---|---|---|---|---|
| Indiana | $558 | $440–$699 | $361 | $934 | 5 | 92 | 0 | EPO, HMO, POS |
| Ohio | $625 | $482–$924 | $395 | $1,023 | 11 | 88 | 0 | HMO |
| South Carolina | $636 | $456–$931 | $374 | $968 | 6 | 46 | 0 | EPO, HMO, POS, PPO |
| Alabama | $680 | $583–$1,124 | $478 | $1,238 | 4 | 67 | 7 | EPO, PPO |
| Wisconsin | $687 | $526–$1,062 | $431 | $1,116 | 12 | 72 | 1 | EPO, HMO, POS, PPO |
| Michigan | $708 | $385–$1,048 | $316 | $818 | 7 | 83 | 0 | EPO, HMO, PPO |
| South Dakota | $725 | $512–$882 | $420 | $1,087 | 3 | 66 | 0 | EPO, HMO, PPO |
| Oklahoma | $731 | $561–$1,300 | $460 | $1,192 | 7 | 77 | 5 | HMO, PPO |
| Kansas | $765 | $565–$979 | $463 | $1,200 | 6 | 105 | 14 | EPO |
| Florida | $789 | $554–$2,203 | $454 | $1,177 | 15 | 67 | 1 | EPO, HMO, POS, PPO |
| Utah | $805 | $559–$1,125 | $526 | $1,134 | 6 | 29 | 1 | EPO, HMO |
| Texas | $807 | $540–$1,409 | $443 | $1,146 | 15 | 254 | 7 | EPO, HMO, POS |
| North Carolina | $828 | $540–$1,128 | $443 | $1,147 | 6 | 100 | 0 | EPO, HMO, POS, PPO |
| Arkansas | $828 | $753–$879 | $617 | $1,599 | 4 | 75 | 0 | POS, PPO |
| Nebraska | $875 | $640–$1,460 | $525 | $1,359 | 5 | 93 | 0 | EPO, PPO |
Methodology
Every figure is derived from the CMS Plan Year 2026 Qualified Health Plan Landscape file, the federal government’s published record of plans certified for sale on the ACA marketplace. We parsed 68,876 individual plan records across 1,314 counties in 15 states.
“Median @40” is the median premium of all Silver-tier plans available to a 40-year-old in that state. “Range” is the lowest and highest Silver premium found in any county. Single-carrier counties are those where exactly one issuer has filed any plan. All premiums are full price before premium tax credits — most self-employed buyers pay substantially less after subsidies.
This index covers the 15 states where Health Advisory is licensed and which use the federal marketplace platform. The following licensed states run their own state-based exchanges and publish rates separately, so they are not included in this edition: Colorado, Georgia, Illinois, Maryland, Nevada, Virginia.
Download the data
The full dataset is available as a CSV under a CC BY 4.0 licence — free to use, republish, and build on, with attribution.
How to cite this
Health Advisory. The Self-Employed Health Insurance Index 2026. Published 2026-07-28.
Derived from the CMS Plan Year 2026 Qualified Health Plan Landscape file.
https://www.coveragebycounty.com/self-employed-health-insurance-index-2026.html
Why this index exists
Self-employed people buy their own health insurance without an HR department, a benefits broker, or a group plan to fall back on. The information they need — what plans actually cost in their county, which carriers are even available, whether a PPO exists at all — is public data that almost nobody publishes in usable form. This index does.
It will be published annually. Media, researchers, and other agents are welcome to use it; the data is free and the licence is open. If you need a figure for a specific county or profession that isn’t covered here, get in touch.
Premiums shown are full-price PY2026 filed rates before any premium tax credit and are not a quote or an offer of coverage. Actual cost depends on age, county, tobacco use, household size, and subsidy eligibility. Verify current rates and availability at enrollment.