Healthcare Costs by State 2026: Insurance, Out-of-Pocket, and Quality Compared
Healthcare is one of the most important and often overlooked components of cost of living. The cheapest states for overall living often have the worst healthcare access, creating a hidden trade-off that can be dangerous for retirees, families with young children, and anyone with chronic health conditions. This page ranks all 50 states by healthcare costs and quality to help you make an informed decision.
All 50 States: Healthcare Cost Rankings
| # | State | HC Index | Avg Annual Cost | Avg Premium | Uninsured % | Hospitals/100k | Medicaid Exp? |
|---|---|---|---|---|---|---|---|
| 1 | Mississippi | 90.2 | $7,080 | $475/mo | 11.8% | 2 | No |
| 2 | Arkansas | 90.9 | $7,120 | $450/mo | 8.4% | 2.2 | Yes |
| 3 | Alabama | 91 | $7,250 | $438/mo | 9.6% | 1.9 | Yes |
| 4 | New Mexico | 91.5 | $7,190 | $398/mo | 10.5% | 2 | Yes |
| 5 | Louisiana | 91.8 | $7,210 | $498/mo | 8.4% | 2.1 | Yes |
| 6 | Oklahoma | 92.5 | $7,260 | $455/mo | 13.2% | 2.4 | Yes |
| 7 | Tennessee | 92.8 | $7,290 | $445/mo | 9.8% | 1.8 | No |
| 8 | Kentucky | 93.3 | $7,320 | $425/mo | 5.3% | 2 | Yes |
| 9 | Utah | 93.5 | $7,340 | $398/mo | 8.5% | 1.4 | Yes |
| 10 | West Virginia | 93.5 | $7,340 | $465/mo | 5.2% | 2.4 | Yes |
| 11 | Arizona | 95.3 | $7,480 | $395/mo | 9.1% | 1.4 | Yes |
| 12 | Georgia | 95.3 | $7,480 | $468/mo | 12.4% | 1.5 | No |
| 13 | Missouri | 95.5 | $7,500 | $425/mo | 8.1% | 2.2 | Yes |
| 14 | Texas | 95.8 | $7,520 | $498/mo | 17.3% | 1.3 | No |
| 15 | Colorado | 96.1 | $7,540 | $425/mo | 6.5% | 1.5 | Yes |
| 16 | Florida | 96.2 | $7,560 | $565/mo | 12.7% | 1.3 | No |
| 17 | Indiana | 96.3 | $7,560 | $415/mo | 7.6% | 1.7 | Yes |
| 18 | Idaho | 96.5 | $7,580 | $410/mo | 8.2% | 2 | Yes |
| 19 | South Carolina | 97.2 | $7,630 | $468/mo | 9.5% | 1.6 | No |
| 20 | Kansas | 98.2 | $7,710 | $405/mo | 7.8% | 2.8 | No |
| 21 | Montana | 98.2 | $7,710 | $445/mo | 7.5% | 3.2 | Yes |
| 22 | Virginia | 98.2 | $7,710 | $455/mo | 7.2% | 1.4 | Yes |
| 23 | Ohio | 98.8 | $7,760 | $408/mo | 6% | 1.7 | Yes |
| 24 | Iowa | 99.5 | $7,810 | $395/mo | 4.8% | 2.5 | Yes |
| 25 | North Carolina | 99.5 | $7,810 | $488/mo | 9.8% | 1.5 | Yes |
| 26 | Michigan | 99.8 | $7,840 | $398/mo | 5.4% | 1.6 | Yes |
| 27 | Nevada | 100.5 | $7,890 | $445/mo | 10.2% | 1.1 | Yes |
| 28 | Nebraska | 101.2 | $7,940 | $410/mo | 6.5% | 3 | Yes |
| 29 | Illinois | 102.5 | $8,050 | $420/mo | 6.2% | 1.4 | Yes |
| 30 | Minnesota | 102.5 | $8,050 | $412/mo | 4.2% | 2.1 | Yes |
| 31 | Washington | 102.5 | $8,050 | $445/mo | 5.8% | 1.3 | Yes |
| 32 | Oregon | 102.8 | $8,080 | $445/mo | 5.8% | 1.5 | Yes |
| 33 | Wisconsin | 102.8 | $8,070 | $418/mo | 4.8% | 1.9 | No |
| 34 | Pennsylvania | 103.5 | $8,120 | $445/mo | 5.5% | 1.8 | Yes |
| 35 | Wyoming | 104.2 | $8,180 | $478/mo | 9.8% | 4.5 | No |
| 36 | Maryland | 107.2 | $8,420 | $488/mo | 6% | 1.3 | Yes |
| 37 | North Dakota | 107.2 | $8,420 | $435/mo | 6.8% | 4.2 | Yes |
| 38 | South Dakota | 107.5 | $8,440 | $448/mo | 8.2% | 3.8 | No |
| 39 | California | 107.8 | $8,620 | $524/mo | 6.8% | 1.1 | Yes |
| 40 | New Jersey | 109.5 | $8,600 | $512/mo | 7.5% | 1.3 | Yes |
| 41 | New York | 110.5 | $8,680 | $575/mo | 5.2% | 1.5 | Yes |
| 42 | Delaware | 112.6 | $8,850 | $510/mo | 5.9% | 1.5 | Yes |
| 43 | Hawaii | 112.6 | $8,850 | $395/mo | 4.1% | 1.6 | Yes |
| 44 | Rhode Island | 115.2 | $9,050 | $478/mo | 3.8% | 1.6 | Yes |
| 45 | Connecticut | 115.8 | $9,180 | $582/mo | 5.2% | 1.7 | Yes |
| 46 | New Hampshire | 115.8 | $9,090 | $458/mo | 5.5% | 1.9 | Yes |
| 47 | Massachusetts | 118.2 | $9,280 | $548/mo | 2.9% | 1.8 | Yes |
| 48 | Vermont | 118.5 | $9,300 | $548/mo | 3.2% | 2.5 | Yes |
| 49 | Maine | 119.5 | $9,380 | $465/mo | 5.8% | 2.3 | Yes |
| 50 | Alaska | 155.7 | $11,890 | $720/mo | 11.2% | 2.8 | Yes |
The Healthcare Trade-Off: Cheap Doesn't Mean Good
One of the most important patterns in cost of living data is the inverse relationship between healthcare cost and healthcare quality. States where healthcare is cheapest often have the worst outcomes, highest uninsured rates, and fewest providers per capita.
Mississippi has the lowest healthcare index (90.2) but also has an 11.8% uninsured rate, has not expanded Medicaid, and has just 2.0 hospitals per 100,000 residents. Contrast this with Massachusetts, which has the highest healthcare costs (118.2 index) but also the lowest uninsured rate in the nation (2.9%), world-class teaching hospitals, and exceptional specialist availability.
For retirees: Healthcare access should be weighted heavily. A low-cost state with limited specialists may require costly travel for procedures that are routine in states with major medical centers. States like Iowa (99.5 healthcare index, 2.5 hospitals per 100k, 4.8% uninsured) offer an excellent middle ground.
For families: Pediatric care availability varies enormously. States that have expanded Medicaid provide a safety net for families with lower incomes. Check whether your target state has expanded Medicaid, particularly if your household income might fluctuate. Visit our retirement guide for healthcare-focused state comparisons.
Medicaid Expansion Status
States that have expanded Medicaid under the ACA provide coverage to adults earning up to 138% of the federal poverty level (approximately $20,800 for a single person in 2026). In non-expansion states, there is often a "coverage gap" where adults earn too much for traditional Medicaid but too little for marketplace subsidies.
States NOT Expanded (10)
States Expanded (40)
All remaining states have expanded Medicaid, providing coverage to low-income adults and reducing uninsured rates. States with expansion typically have uninsured rates 2-5 percentage points lower than non-expansion states.
Frequently Asked Questions
What state has the cheapest healthcare?
Mississippi has the lowest healthcare sub-index at 90.2, with average annual healthcare spending around $7,080 per person. However, low cost often correlates with lower access: Mississippi has an 11.8% uninsured rate and fewer specialists per capita. States like Iowa and Minnesota offer moderate costs with excellent healthcare access.
What state has the most expensive healthcare?
Alaska has the highest healthcare sub-index at 155.7, with average annual spending of $11,890 per person. The state's remote geography, small population, and extreme climate drive up costs for healthcare delivery. On the mainland, Maine (119.5), Massachusetts (118.2), and Vermont (118.5) lead.
Which states have expanded Medicaid?
As of 2026, 40 states plus DC have expanded Medicaid under the ACA. The 10 states that have NOT expanded are: Alabama (expanded in 2024, actually), Florida, Georgia, Kansas, Mississippi, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. Non-expansion states tend to have higher uninsured rates.
How much do health insurance premiums vary by state?
ACA marketplace premiums for a benchmark silver plan vary significantly: from about $395/month in Hawaii and Arizona to over $720/month in Alaska. The average across all states is approximately $450-$500/month for a 40-year-old nonsmoker. Premium variation is driven by provider costs, competition among insurers, state regulations, and population health.