Not all rural areas will see big increases, Quinn notes: North Dakota and Wyoming "had some of the lowest premium increases this year at 7 percent." Denise Burke, with the Wyoming Department of Insurance, attributed those increases to proper rate-setting that moved the states from having some of the nation's highest premiums to a more middle ground.
Burke pointed out that Wyoming doesn't have any urban centers to compete with for prices and providers: "We're a rural state across the board. There's really no distinction from one county to the other when it comes to population. We're always going to be an expensive state—we just don't have the population centers to make us financially viable."
In Missouri, rates are expected to be about 50 percent more in rural areas than urban ones, Patrick Ishmael, director of government accountability at the Show-Me Institute, writes for Forbes. "There are whole swaths of Missouri that won't be seeing either the 'best' or the 'cheapest' insurance options that other Missourians see because insurers are unwilling to offer those plans under current market insurance condit."
In Iowa 13 rural counties will only have one plan to choose from, Tony Leys reports for The Des Moines Register. While Colorado will have an average increase of 20 percent, largely rural eastern Colorado will see an average increase of 39 percent, and the Grand Junction area and Mesa County 37 percent, compared to 17 percent in Denver, Blair Miller reports for The Denver Channel.