Imagine not paying a single dollar in monthly premiums for health insurance—sounds like a dream, right? In 2025, certain states are making that possible for eligible residents. Whether through Medicaid expansion, state-funded subsidies, or zero‑premium marketplace plans, you might qualify for comprehensive coverage at no cost under the right conditions.
In this article, we’ll:
Explain why and how some states offer $0‑premium or no‑premium health insurance.
Highlight 7 U.S. states where this is a reality in 2025.
Provide a comparison table for clarity.
Walk you through eligibility considerations.
Wrap up with take‑away tips for readers, whether in the U.S. or Canada.
Let’s dive in.
Why some people pay $0—and how it works
Various mechanisms make this possible:
1. Medicaid expansion under the ACA
The Affordable Care Act (ACA) allowed states to expand Medicaid to adults earning up to 138% of the Federal Poverty Level (FPL). As of mid‑2025, 41 states plus D.C. have expanded Medicaid, while 10 holdouts remain (like Texas, Florida, etc.) where many low-income adults fall into a “coverage gap” (healthinsurance.org, Verywell Health, GovFacts). In expansion states, eligible adults can enroll at $0 premium, and often minimal cost-sharing.
2. Zero-premium ACA Marketplace plans
Thanks to enhanced subsidies under the American Rescue Plan and the Inflation Reduction Act, some Silver-tier plans on the ACA Marketplace now come with $0 monthly premium for many enrollees, even beyond the poorest income brackets. These enhanced subsidies are currently effective through 2025, though their continuation depends on future legislation (healthinsurance.org).
3. State-funded programs for immigrants or unique groups
A few states go further—offering fully state-funded coverage, including to undocumented immigrants. In states like California, New York, Minnesota, Oregon, Colorado, Washington, Illinois, and D.C., comprehensive coverage, sometimes similar to Medicaid, is available regardless of immigration status—and often at no cost to eligible individuals (KFF).
U.S. States Where You Could Pay $0 for Health Insurance in 2025
Here are seven states where, under current rules, eligible residents could literally pay $0 for health insurance in 2025:
California
New York
Minnesota
Oregon
Colorado
Washington
Pennsylvania(special cases of continuous eligibility and subsidies)
Medicaid expansion + Essential Plan w/$0 premium for 150–200% FPL
Excellent coverage
Minnesota
Expanded Medicaid; state-funded programs include Basic Health Program (BHP) covering 133–200% FPL regardless of status
Strong immigrant access
Oregon
Medicaid expansion (OHP Plus, $0 premiums)
Also moving toward universal healthcare
Colorado
Medicaid expansion; OmniSalud marketplace subsidy regardless of status (but capped enrollment)
Capped but powerful
Washington
Medicaid expansion; market subsidies via Cascade Care, state funding extended to immigrants (capped and paused enrollment)
Enrollment caps notable
Pennsylvania
Medicaid expansion; continuous eligibility initiatives via Section 1115 (keeps coverage active longer)
Subsidies being considered
This table spotlights states offering real potential for zero-dollar health insurance in 2025 through various mechanisms.
How each state stands out 💡
1. California
Medi‑Cal offers full-scope coverage with no premiums, including to low‑income undocumented adults since late 2023/early 2024 (Wikipedia). That makes California one of the only states where immigration status doesn’t block access for the poorest.
2. New York
Apart from Medicaid expansion, New York’s Essential Plan offers zero-premium insurance for households at 150–200% FPL, with minimal cost‑sharing and modest out‑of‑pocket maximums (NILC, Reddit).
3. Minnesota
Minnesota uses a Basic Health Program (BHP) so that people with 133–200% FPL can get lower premiums and cost sharing than Marketplace plans—and this covers immigrants regardless of status starting 2025.
4. Oregon
Under OHP Plus, all Medicaid-eligible children and adults receive full benefits with no premiums, though some adults may face small copays (Wikipedia). Oregon is also actively planning for universal healthcare, potentially expanding even further in coming years.
5. Colorado
In addition to expansion Medicaid, Colorado runs OmniSalud, a state‑funded subsidy for immigrants to buy Marketplace plans. Though enrollment is capped at around 12,000, eligible participants receive $0‑premium coverage.
6. Washington
Cascade Care marketplace plans, subsidized via a state Section 1332 waiver, have offered zero‑premium access up to 250% FPL, including immigrants. However, subsidies have paused for 2025, enrollment capped . Still notable.
7. Pennsylvania
While the state itself hasn’t yet created broad subsidies, CMS approved continuous eligibility expansions in 2024: children keep coverage until age 6, and some adults (e.g. formerly incarcerated individuals) get 12‑month coverage continuity (CMS). Pennsylvania is developing a state-funded subsidy, possibly effective in 2026 (healthinsurance.org).
Broader context: Why this matters
Millions of Americans remain uninsured, particularly in non-expansion states, where low-income adults earn too much for traditional Medicaid but too little to get subsidies—known as the coverage gap (UP Excise Portal).
The availability of zero‑premium marketplace plans is temporary—enhanced federal subsidies expire at end of 2025 unless renewed; hence 2025 is a crucial year (healthinsurance.org).
For immigrant populations, state-level programs in places like California, New York, Minnesota, Oregon, Colorado, Washington are vital lifelines—not just for legal residents but undocumented individuals too .
Canadian perspective: How does Canada compare?
While this article focuses on the U.S., it’s helpful to touch on Canada’s universal, publicly funded healthcare model, especially for comparisons:
In Canada, residents (with provincial health insurance) pay no premiums at point-of-care—not just designated states.
Provincial coverage includes hospital care and primary physician visits, but prescription drugs, dental, vision, and mental health are often not fully covered, or may involve additional provincial programs.
Some provinces (e.g., British Columbia, Ontario, Quebec) offer income-based subsidies for supplemental drug or dental programs, but no province provides full zero-premium coverage for everything across all populations.
Unlike Canada’s universal model, the U.S. patchwork of federal and state programs creates uneven access, making the zero-premium winning states notable exceptions.
So, while Canadians generally enjoy near-universal access, some Americans in specific states in 2025 may achieve similar no-cost outcomes, albeit through different mechanisms.
Tips for qualifying or finding out if you can pay $0 in your state
Check your state’s Medicaid expansion status and eligibility thresholds via official health department sites.
During ACA open enrollment (e.g. Nov 2024–Jan 2025 for coverage in 2025), use Healthcare.gov or your state exchange to see zero‑premium plan options if you’re at certain income levels.
If you’re an immigrant, review whether your state has state-funded coverage programs regardless of immigration status.
Monitor legislative developments—some states (e.g., Pennsylvania) are debating state subsidies for 2026 forward.
Act swiftly in 2025: the federal subsidy enhancements expire unless renewed, so zero-premium plans may disappear in 2026.
Conclusion
In 2025, a breakthrough of relief exists: in selected states—California, New York, Minnesota, Oregon, Colorado, Washington, and Pennsylvania—eligible residents can potentially secure comprehensive health insurance at $0 monthly premium. Whether through Medicaid expansion, state-funded immigrant coverage, or zero‑premium Marketplace plans, this is real, impactful coverage.
As federal subsidies may expire at the end of 2025, this window is particularly precious. If you’re in one of these states, or planning to move, now is the time to check eligibility and enroll.
For Canadians curious, while the U.S. approach remains complex, these states represent rare situations where affordability aligns with access—approaching, in some ways, Canadian-style zero-premium healthcare for those who qualify.
External References
Learn more about Medicaid expansion status and non-expansion states: visit this state-by-state expansion guide.
Discover who qualifies for zero-premium plans and how federal subsidies are affecting availability.
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