A 60-year-old buying an Affordable Care Act plan on the open market pays a very different bill depending on the state on the mailing address. New KFF analysis of what happened after the enhanced premium tax credits expired puts the annual increase for someone in Wyoming at $22,452 for a benchmark silver plan, the largest state-level jump found anywhere in the country. In New York, the same-aged shopper absorbs an increase of $4,469 for the identical type of plan. Both enrollees lost the same federal policy on the same date, at the end of 2025, yet one household’s bill rose roughly five times more than the other’s. The distance between those two numbers comes down to three things: income rules that treat every state the same on paper, insurance markets that look nothing alike underneath, and an age-rating formula that hits people in their sixties hardest everywhere.
The $22,452 Gap at 401% of the Poverty Line
The KFF figures track a specific household: a 60-year-old earning just over 401% of the federal poverty line, or $62,757 a year outside Alaska and Hawaii, buying a benchmark silver plan without any help from the enhanced premium tax credits that expired at the end of 2025. KFF’s analysis found the increase for that household runs highest in Wyoming ($22,452), West Virginia ($22,006) and Alaska ($19,636), and lowest in New York ($4,469), Massachusetts ($4,728) and New Hampshire ($4,877). A separate KFF mapping brief built from the same underlying premium data found that 46 states and the District of Columbia will see this household’s premium payment at least double, and in 19 of those states it at least triples. Wyoming sits at the far edge of that second group. The same KFF page shows the state’s unsubsidized bronze-plan premium for a 60-year-old, $20,005 a year before any tax credit is even applied, is the highest baseline in the nation, well above Maryland’s $7,215 and New York’s $7,318. The steepest increases fall on this narrow income band because it is the only group that lost federal help entirely; the KFF mapping brief notes that out-of-pocket premiums for enrollees below 400% of poverty, who still qualify for some tax credit, rose by hundreds of dollars to roughly $1,500 a year on average, a fraction of what the Wyoming household above the income cap now owes.
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Two Insurers Are Left Selling in Wyoming’s Exchange
Wyoming’s high starting premium is not an accident of geography alone; it traces to how few companies are willing to sell coverage there. Wyoming’s HealthCare.gov rate filings, reviewed on healthinsurance.org’s Wyoming marketplace guide, show the exchange narrowed to two carriers for 2026, Blue Cross Blue Shield of Wyoming and UnitedHealthcare, after Mountain Health CO-OP exited the state at the end of 2025 and left the field down from three insurers. A thin field of insurers means less pressure on any one carrier to hold down its rates, and it is a national pattern, not just a Wyoming one. KFF’s tracking of insurer participation found the average number of issuers per state fell from a record 9.6 in 2025 to 9.0 in 2026, and the number of counties nationwide with only a single ACA insurer more than tripled, from 93 to 165. Sparsely populated states like Wyoming, West Virginia and Alaska sit at the thin end of that distribution; a carrier weighing whether to build a network across a small, spread-out population has less to gain than one weighing whether to sell in New York or California, where enrollment is large enough to support a dozen or more competing plans.
Why New York and Massachusetts Absorb a Smaller Hit
The states cushioned from the worst of the increase are, almost without exception, larger or more urban markets where insurers already compete for a bigger pool of enrollees and where regulators have spent years pushing baseline premiums down before the tax-credit expiration ever entered the picture. New York and Massachusetts both run insurance markets with additional state-level consumer protections layered on top of the federal ACA rules, and both already carried the lowest unsubsidized bronze premiums for older enrollees in KFF’s national comparison. When a state’s starting premium is a fraction of Wyoming’s, the same percentage-based loss of federal assistance produces a far smaller dollar swing, even though every state lost the enhanced credits on the identical date. That is the mechanical reason a policy change written the same way for all 50 states produced a $22,452 hit in one and a $4,469 hit in another, and it is also why West Virginia and Alaska, both large, low-density states with thin insurer rosters of their own, land right behind Wyoming rather than anywhere near the middle of the pack.
The Age-Rating Multiplier Behind the Wyoming Number
Layered on top of the geographic split is a federal rule that applies everywhere: insurers selling ACA and other individual-market plans are allowed to charge older adults up to three times what they charge someone in their twenties for the same coverage, under the age-rating band KFF confirms is federal policy for individual and small-group plans. That multiplier is why the pain concentrates so heavily on people in their late fifties and sixties rather than younger enrollees losing the same tax credit. In Wyoming, a thin insurer field pushes the baseline premium to the top of the national range, the age-rating band multiplies that baseline for a 60-year-old, and the loss of the enhanced tax credit removes the subsidy that used to offset both. Each factor is measurable on its own in KFF’s published tables; together, they are what turns a national policy change into a $22,452 state-level number.
Where ACA-Era Cost Tracking Ends and Medicare’s Begins
The KFF analysis stops at the ACA exchange, but for a 60-year-old absorbing a five-figure premium jump, the cost-tracking problem does not end there. Within a few years, that same household ages into Medicare, where a different set of premium surcharges, drug-cost caps and appeal deadlines takes over as the thing that determines what coverage actually costs. Few people map that transition in advance, and the paperwork that would help them do it rarely surfaces until a bill or a denied claim already forces the question.
The Medicare Cost & Coverage Protection Kit is a 10-page kit built around 51 state Medicare cost-help packs, the new Part D out-of-pocket cap, the prior-authorization appeal steps, and a medication and cost tracker.
Compare the state cost-help pack against the prior-authorization appeal steps in The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by an editor.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
