Florida, Texas, and Arizona are the three most common destinations Americans 55–64 consider for pre-retirement relocation. They also happen to have some of the highest ACA marketplace premiums in the United States. This comparison examines what healthcare actually costs in each of these "retirement-friendly" states versus Spain's Convenio Especial — on a line-item basis including premiums, deductibles, out-of-pocket costs, and drug prices.
The numbers are not close.
Calculate your savings vs. your current state's ACA premiums on the TheCureGap calculator.
ACA Premiums by State for Ages 55–64 (2026)
ACA premiums vary by state because each state's insurance market has different carrier competition, risk pools, and regulatory environments. Florida, Texas, and Arizona all have above-average premiums for the 55–64 cohort:
| State | Monthly Premium (Age 60) | Annual Premium | Monthly Premium (Age 64) | Annual Premium (Age 64) |
|---|---|---|---|---|
| Florida | $1,680–$1,850 | $20,160–$22,200 | $1,900–$2,100 | $22,800–$25,200 |
| Texas | $1,650–$1,820 | $19,800–$21,840 | $1,850–$2,050 | $22,200–$24,600 |
| Arizona | $1,580–$1,750 | $18,960–$21,000 | $1,780–$1,950 | $21,360–$23,400 |
| US National Average | $1,598 | $19,176 | $1,766 | $21,192 |
| Spain (Convenio Especial) | €60 (~$66) | ~$792 | €60 (~$66) | ~$792 |
Sources: KFF Health Insurance Marketplace Calculator 2026 (state-level benchmarks); Seguridad Social Spain fee schedule 2026.
Total Annual Healthcare Cost Including Deductibles and Out-of-Pocket
The premium is only part of the story. For a 60-year-old with typical chronic condition utilization (1–2 chronic conditions, 4–6 doctor visits per year, 2–3 prescription medications), the all-in annual cost looks substantially different from the premium alone:
| Location | Annual Premium | Average Deductible | Annual Rx Costs (2 meds) | Specialist Copays (4 visits) | Total Estimated Annual Cost |
|---|---|---|---|---|---|
| Florida (age 60) | $21,000 | $4,500 | $2,400 | $160 | $28,060 |
| Texas (age 60) | $20,820 | $4,500 | $2,400 | $160 | $27,880 |
| Arizona (age 60) | $19,980 | $4,500 | $2,400 | $160 | $27,040 |
| Spain — Convenio Especial (age 60) | $792 | $0 | $222 (capped) | $0 | $1,014 |
The annual differential at age 60: $27,000–$28,000. Over five years (ages 60–65): $135,000–$140,000 for an individual. For a couple, the five-year differential exceeds $275,000.
State-by-State Profile: Healthcare Risks
Florida
Florida is the most popular retirement destination in the US and has one of the most expensive ACA marketplaces. Key facts for the 55–64 cohort:
- ACA premiums for age 60 average $1,680–$1,850/month, among the highest in the nation
- Limited carrier competition in many counties — in 2026, some Florida counties have only 2 insurer options on the marketplace
- High healthcare utilization rates driven by older population demographics
- No state income tax, but healthcare costs negate this advantage for the 55–64 cohort
- Large uninsured population — 11.2% of adults uninsured vs. 0% in Spain (universal coverage)
Texas
Texas has the highest uninsured rate of any large US state (18.4% of adults) and did not expand Medicaid under the ACA. For the 55–64 cohort who don't qualify for Medicaid, the marketplace is their only subsidized option:
- ACA benchmark premiums: $1,650–$1,820/month for age 60
- Some markets with thin carrier competition (rural Texas counties have had single-insurer markets)
- No state income tax
- Provider shortages in rural areas
- High out-of-pocket exposure — Texas ACA plans tend to have above-average deductibles
Arizona
Arizona has improved its insurance market competition since the near-collapse years of 2017–2018 but remains expensive for the pre-Medicare cohort:
- ACA benchmark premiums: $1,580–$1,750/month for age 60
- Arizona expanded Medicaid (covers adults up to 138% FPL) — for those above the threshold, marketplace plans apply
- Hotter climate associated with higher rates of certain conditions (heat-related illness, skin cancer) — relevant to healthcare utilization
- Strong retirement infrastructure but not matched by affordable healthcare for pre-Medicare ages
The "Low-Tax State" Calculation Gets Complicated
Americans choosing Florida, Texas, or Arizona for pre-retirement relocation often cite no state income tax as a financial advantage. This is real — but for the 55–64 cohort, healthcare costs dwarf state income tax savings:
| Financial Factor | Florida/Texas/AZ vs. High-Tax State | Spain vs. Florida/Texas/AZ |
|---|---|---|
| State income tax savings (vs. CA/NY) | ~$3,000–$8,000/year | N/A |
| Healthcare cost savings | Minimal (same federal ACA structure) | ~$27,000/year (age 60) |
| Net financial advantage | $3,000–$8,000 from tax only | ~$27,000 from healthcare |
Moving from California to Florida saves roughly $5,000/year in state income taxes for a $100,000 income. Moving from Florida to Spain saves $27,000/year in healthcare costs for the same person. The healthcare arbitrage is 3–5x larger than the tax arbitrage that drives most US domestic relocation decisions.
Housing Cost Context
Spain is often assumed to be unaffordable compared to Sun Belt states. The data is more nuanced:
| Location | Monthly Rent (2-bed, urban area) | Monthly Healthcare Cost (age 60) | Combined |
|---|---|---|---|
| Miami, FL | $2,800–$3,500 | $1,680–$1,850 (ACA) | $4,480–$5,350 |
| Austin, TX | $1,900–$2,600 | $1,650–$1,820 (ACA) | $3,550–$4,420 |
| Scottsdale, AZ | $2,000–$2,700 | $1,580–$1,750 (ACA) | $3,580–$4,450 |
| Madrid, Spain | $1,500–$2,200 | €60 ($66, Convenio Especial) | $1,566–$2,266 |
| Valencia, Spain | $900–$1,400 | €60 ($66) | $966–$1,466 |
| Málaga, Spain | $900–$1,300 | €60 ($66) | $966–$1,366 |
The combined rent + healthcare cost for a comparable-quality life in Valencia or Málaga is less than half the equivalent cost in Miami or Austin.
The Retirement Calculation
For an American who has saved $800,000 for retirement and is considering whether to retire in Florida, Texas, Arizona, or Spain:
| Scenario | Annual Healthcare Cost (age 60, couple) | 5-Year Healthcare Total | % of $800K Savings |
|---|---|---|---|
| Florida | ~$56,000 | ~$280,000 | 35% |
| Texas | ~$55,000 | ~$275,000 | 34% |
| Spain (Convenio Especial) | ~$1,580 | ~$7,900 | 1% |
A couple retiring in Florida spends 35% of their retirement savings on healthcare over five years, before Medicare. The same couple in Spain spends 1%.
Your State vs. Spain: Run the Numbers
The TheCureGap savings calculator lets you input your current state, age, and ACA premium to see a personalized Spain cost comparison including 5-year and 10-year projections.
Compare My CostsSources
- KFF Health Insurance Marketplace Calculator (2026) — state-level premium benchmarks
- Seguridad Social Spain — Convenio Especial fee schedule 2026
- US Census Bureau — State uninsured rates 2025
- Numbeo — Rent data for Spain cities and US cities (Q1 2026)
- OECD Health Statistics 2024