Healthcare Costs by State 2026
Average ACA marketplace premiums, annual healthcare spending, and uninsured rates for all 50 states. Plus the trade-off no one talks about: cheap healthcare states often have the worst access.
All 50 states
Healthcare costs ranked
| State | Healthcare index | Annual spend (per person) | Avg ACA premium | Uninsured | Hospitals/100k | Medicaid |
|---|---|---|---|---|---|---|
| Mississippi | 90.2 | $7,080 | $475/mo | 11.8% | 2.0 | Not expanded |
| Arkansas | 90.9 | $7,120 | $450/mo | 8.4% | 2.2 | Expanded |
| Alabama | 91.0 | $7,250 | $438/mo | 9.6% | 1.9 | Expanded |
| New Mexico | 91.5 | $7,190 | $398/mo | 10.5% | 2.0 | Expanded |
| Louisiana | 91.8 | $7,210 | $498/mo | 8.4% | 2.1 | Expanded |
| Oklahoma | 92.5 | $7,260 | $455/mo | 13.2% | 2.4 | Expanded |
| Tennessee | 92.8 | $7,290 | $445/mo | 9.8% | 1.8 | Not expanded |
| Kentucky | 93.3 | $7,320 | $425/mo | 5.3% | 2.0 | Expanded |
| Utah | 93.5 | $7,340 | $398/mo | 8.5% | 1.4 | Expanded |
| West Virginia | 93.5 | $7,340 | $465/mo | 5.2% | 2.4 | Expanded |
| Arizona | 95.3 | $7,480 | $395/mo | 9.1% | 1.4 | Expanded |
| Georgia | 95.3 | $7,480 | $468/mo | 12.4% | 1.5 | Not expanded |
| Missouri | 95.5 | $7,500 | $425/mo | 8.1% | 2.2 | Expanded |
| Texas | 95.8 | $7,520 | $498/mo | 17.3% | 1.3 | Not expanded |
| Colorado | 96.1 | $7,540 | $425/mo | 6.5% | 1.5 | Expanded |
| Florida | 96.2 | $7,560 | $565/mo | 12.7% | 1.3 | Not expanded |
| Indiana | 96.3 | $7,560 | $415/mo | 7.6% | 1.7 | Expanded |
| Idaho | 96.5 | $7,580 | $410/mo | 8.2% | 2.0 | Expanded |
| South Carolina | 97.2 | $7,630 | $468/mo | 9.5% | 1.6 | Not expanded |
| Kansas | 98.2 | $7,710 | $405/mo | 7.8% | 2.8 | Not expanded |
| Montana | 98.2 | $7,710 | $445/mo | 7.5% | 3.2 | Expanded |
| Virginia | 98.2 | $7,710 | $455/mo | 7.2% | 1.4 | Expanded |
| Ohio | 98.8 | $7,760 | $408/mo | 6.0% | 1.7 | Expanded |
| Iowa | 99.5 | $7,810 | $395/mo | 4.8% | 2.5 | Expanded |
| North Carolina | 99.5 | $7,810 | $488/mo | 9.8% | 1.5 | Expanded |
| Michigan | 99.8 | $7,840 | $398/mo | 5.4% | 1.6 | Expanded |
| Nevada | 100.5 | $7,890 | $445/mo | 10.2% | 1.1 | Expanded |
| Nebraska | 101.2 | $7,940 | $410/mo | 6.5% | 3.0 | Expanded |
| Illinois | 102.5 | $8,050 | $420/mo | 6.2% | 1.4 | Expanded |
| Minnesota | 102.5 | $8,050 | $412/mo | 4.2% | 2.1 | Expanded |
| Washington | 102.5 | $8,050 | $445/mo | 5.8% | 1.3 | Expanded |
| Oregon | 102.8 | $8,080 | $445/mo | 5.8% | 1.5 | Expanded |
| Wisconsin | 102.8 | $8,070 | $418/mo | 4.8% | 1.9 | Not expanded |
| Pennsylvania | 103.5 | $8,120 | $445/mo | 5.5% | 1.8 | Expanded |
| Wyoming | 104.2 | $8,180 | $478/mo | 9.8% | 4.5 | Not expanded |
| Maryland | 107.2 | $8,420 | $488/mo | 6.0% | 1.3 | Expanded |
| North Dakota | 107.2 | $8,420 | $435/mo | 6.8% | 4.2 | Expanded |
| South Dakota | 107.5 | $8,440 | $448/mo | 8.2% | 3.8 | Not expanded |
| California | 107.8 | $8,620 | $524/mo | 6.8% | 1.1 | Expanded |
| New Jersey | 109.5 | $8,600 | $512/mo | 7.5% | 1.3 | Expanded |
| New York | 110.5 | $8,680 | $575/mo | 5.2% | 1.5 | Expanded |
| Delaware | 112.6 | $8,850 | $510/mo | 5.9% | 1.5 | Expanded |
| Hawaii | 112.6 | $8,850 | $395/mo | 4.1% | 1.6 | Expanded |
| Rhode Island | 115.2 | $9,050 | $478/mo | 3.8% | 1.6 | Expanded |
| Connecticut | 115.8 | $9,180 | $582/mo | 5.2% | 1.7 | Expanded |
| New Hampshire | 115.8 | $9,090 | $458/mo | 5.5% | 1.9 | Expanded |
| Massachusetts | 118.2 | $9,280 | $548/mo | 2.9% | 1.8 | Expanded |
| Vermont | 118.5 | $9,300 | $548/mo | 3.2% | 2.5 | Expanded |
| Maine | 119.5 | $9,380 | $465/mo | 5.8% | 2.3 | Expanded |
| Alaska | 155.7 | $11,890 | $720/mo | 11.2% | 2.8 | Expanded |
Sources: KFF Health System Tracker 2026, Healthcare.gov marketplace data, US Census ACS, AHA hospital data.
The hidden trade-off
Cheap healthcare doesn't mean good healthcare.
Mississippi has the cheapest healthcare sub-index but the worst rural hospital access in the country - 13 rural hospitals have closed since 2010. Oklahoma and Texas have low indices but the highest uninsured rates. The Commonwealth Fund's annual scorecards consistently put cheap-healthcare states in the bottom 10 for outcomes.
For young, healthy adults this matters less. For retirees, families with chronic conditions, or anyone planning to start a family, healthcare quality should weight alongside cost. Massachusetts is expensive but world-class; Vermont and Hawaii score well on access despite higher costs.
Frequently Asked
Healthcare costs, answered
Which state has the cheapest healthcare?
Mississippi on the C2ER healthcare sub-index at 90.2, with average annual healthcare spending around $7,080 per person. The catch: cheapest doesn't mean best access. The Commonwealth Fund's healthcare scorecards consistently rank the cheapest states in the bottom half for access and quality.
What state has the highest healthcare costs?
Alaska at index 155.7, driven by high insurance premiums, expensive specialist care, and limited rural delivery infrastructure. Massachusetts and Maine also rank high; both have universal-ish coverage but high underlying medical pricing.
How much does an ACA marketplace plan cost?
The unsubsidised average for a silver plan, single adult age 40, ranges from $395/month (lowest, Hawaii and Arizona) to $720/month (highest, Alaska). Subsidies under the ACA can reduce premiums substantially based on household income. The Healthcare.gov plan finder tool shows your actual subsidised cost.
Which states haven't expanded Medicaid?
Of 50 states, 40 have expanded Medicaid under the ACA. The non-expansion states (Alabama, Florida, Georgia, Mississippi, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming) leave a coverage gap for adults earning between 100% of the federal poverty level and the threshold for marketplace subsidies. This contributes to higher uninsured rates: Texas (17.3%), Oklahoma (13.2%), Florida (12.7%) lead the country.
Should retirees prioritise healthcare quality over cost?
Almost always. Healthcare needs increase substantially with age, and a 'cheap' state with limited rural hospital coverage can mean long drives, poor specialist access, or worse outcomes for chronic conditions. Massachusetts and Vermont consistently top healthcare quality rankings; their costs are higher but for retirees with assets, the trade-off often favours quality. See our retirement page for the composite ranking.