SANTA CRUZ -- The price of health care under the Affordable Care Act varies widely depending on where you live, and in Santa Cruz County that means some of the highest premiums in the country.

According to a 50-state analysis by the Sentinel and other newspapers, the Central Coast pays a high price health coverage compared to other regions in California and across the country.

One silver lining is that the costs can be heavily offset by tax subsidies for many middle- and lower-income families. But families that don't qualify for a tax break will see health care affordability promised under the new law fall off a cliff.

"The ones on the edges, it's really a dangerous spot to sit on. Subsidy versus no subsidy is so dramatic, and it's a worry," said Sharon Martin, a Santa Cruz-based broker at Dettle Insurance Agency. "You make a few dollars more and it makes a huge difference."

The Sentinel analyzed premium and subsidy data for the federal health care exchange and each of the 16 states operating their own exchanges, including Covered California. Within each state, rates are further broken down into rating areas, with 501 in total across the nation.

It makes a difference where you live. Santa Cruz and the Central Coast have among the highest premiums in the country, ranking 26th out of 501, and fourth-highest in California.

San Mateo County leads the state in premium costs, and, for a 50-year-old nonsmoker shopping for a so-called "silver" plan, costs nearly $200 a month more than if the same person lived in the eastern part of the Los Angeles basin.

Experts say the different prices are due to the availability of doctor, hospital and clinic networks, whether health care giant Kaiser-Permanente is a local operator and if there is robust regional competition, with sparsely served rural areas often facing higher rates.

"Some of those same characteristics are true (on the Central Coast)," said Marian Mulkey, director of health reform and public programs at the California HealthCare Foundation. "There are only a couple of hospitals, and there are some providers with some pretty significant negotiating clout."

Another factor is whether there are large numbers of uninsured who suddenly became buyers under the law. While the number of people with insurance on the Central Coast has been relatively high, competition for buyers appears to be pushing down prices in some areas.

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In Santa Cruz, affordable health care elusive for some: High premiums, aided by high subsidies