If you’ve ever felt the pinch of healthcare expenses, you’re not alone. Unexpected medical bills and the cost of healthcare services are the top two financial worries for Americans this year, according to a recent KFF health tracking poll. The poll found that 45% of adults are very worried about being able to afford unexpected medical bills, while 39% are very worried about their ability to cover the cost of healthcare services.
These financial fears have real-world consequences. The high cost of healthcare is leading some Americans to make tough choices—often at the expense of their health. Nearly two in five adults between the ages of 19 and 64 delayed or skipped healthcare services between 2022 and 2023 because they couldn’t afford it, a survey from The Commonwealth Fund found. This includes putting off doctor visits, medical procedures and prescription drug refills.
But the burden of healthcare costs isn’t distributed evenly across the country. In some states, residents face much steeper healthcare expenses, including higher premiums and deductibles, which make them more likely to delay medical care due to costs.
To shed light on where healthcare costs hit the hardest, our experts conducted an analysis comparing all 50 states and Washington, D.C. across nine key metrics. The findings of this study reveal which states are the most and least expensive for healthcare in 2024.
Key Takeaways
- North Carolina ranks as the most expensive state for healthcare, while Hawaii is the most affordable.
- Six of the top 10 most expensive states for healthcare are located in the South: North Carolina, Florida, Texas, South Carolina, Georgia and Louisiana.
- In contrast, the Pacific and West—Hawaii, Washington, California, Nevada and Oregon— account for half of the top 10 most affordable states for healthcare.
- Texas residents are the most likely in the nation to report forgoing a doctor’s visit in the past 12 months due to cost (16%).
Top 5 Most Expensive States For Healthcare
1. North Carolina
North Carolina’s score: 100 out of 100
North Carolina is the most expensive state for healthcare, with the highest average premium for residents with “plus-one” health insurance coverage through an employer ($4,781 annually).
- North Carolina has the second highest average premium for residents with family health insurance coverage through an employer ($7,180.33 annually).
- The state reports having the fifth highest average deductible for residents with single health insurance coverage through an employer ($2,267.67 annually).
- It ranks 11th highest for average deductible for residents with family health insurance coverage through an employer ($4,061.67 annually).
2. South Dakota
South Dakota’s score: 93.41 out of 100
South Dakota is the second most-expensive state for healthcare. It has these key statistics:
- South Dakota ranks fourth highest for its percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (11.9%).
- It also has the fourth highest average deductible for residents with single health insurance coverage through an employer ($2,433 annually).
- South Dakota features the fifth highest average deductible for residents with family health insurance coverage through an employer ($4,330.67 annually).
- The state also has the sixth highest average premium for residents with plus-one health insurance coverage through an employer ($4,599.33 annually).
- Additionally, South Dakota has the sixth highest health insurance premium for those with silver plans in the Affordable Care Act marketplace ($596.67 annually).
3. Nebraska
Nebraska’s score: 93.09 out of 100
Healthcare expenses are also high in the Cornhusker State. Nebraska residents face these key metrics:
- The state has the third highest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (12.1%).
- Nebraska is noted for having the seventh highest annual premium for both single health insurance coverage ($1,796.33) and plus-one health insurance coverage ($4,530.67) through an employer.
- It ranks eighth highest for average premium for residents with family health insurance coverage through an employer ($6,766.33 annually).
- It also has the eighth highest health insurance premium for those with silver plans in the Affordable Care Act marketplace ($570 annually).
4. Florida
Florida’s score: 92.50 out of 100
Floridians may enjoy a lack of state tax and an abundance of sunshine, but they live in a state with the highest average premium for families.
- Florida has the highest average premium for residents with family health insurance coverage through an employer ($7,258 annually).
- Florida has the second highest average premium for residents with plus-one health insurance coverage through an employer ($4,727.33 annually).
- Florida is home to the fourth highest percentage of adults who chose not to see a doctor at some point in the past 12 months due to cost (14.4%).
- The state also has the fourth highest percentage of adults reporting 14 or more mentally unhealthy days a month who could not see a doctor due to cost (30.1%).
- Additionally, Florida has the eighth highest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (11.1%).
5. Texas
Texas’ score: 91.38 out of 100
Trailing in closely behind Florida is Texas—another state that many families are flocking to due to its affordability. If you live in the Lonestar State or are considering a move, be aware of these key healthcare statistics:
- Texas has the highest percentage of adults who chose not to see a doctor at some point in the past 12 months due to cost (16%).
- It also has the highest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (14.9%).
- Texas ranks third highest for its percentage of adults reporting 14 or more mentally unhealthy days a month who could not see a doctor due to cost (31.5%).
- The state exhibits the fourth highest annual premium for both plus-one health insurance coverage ($4,626) and family health insurance coverage ($7,051.33) through an employer.
Top 5 Most Affordable States For Healthcare
1. Hawaii
Hawaii’s score: 0 out of 100
Hawaii sets the benchmark for having the most affordable healthcare in the U.S. It earned a perfect score of 0 on our healthcare cost ranking index and boasts the lowest percentages and costs in several key metrics:
- Hawaii records the lowest percentage of adults who chose not to see a doctor at some point in the past 12 months due to cost (5.7%).
- It also has the lowest percentage of adults reporting 14 or more mentally unhealthy days a month who could not see a doctor due to cost (11.6%).
- Hawaii boasts the lowest average premium for residents with single health insurance coverage through an employer ($911 annually).
- It also has the lowest average deductible for residents with single health insurance coverage through an employer ($1,310 annually).
- Hawaii has the second lowest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (5.7%).
- Hawaii residents with family health insurance coverage through an employer pay the second lowest average deductible ($3,115 annually).
- Hawaii has the third lowest average premium for residents with plus-one health insurance coverage through an employer ($3,654.67 annually).
- It boasts the fourth lowest average premium for residents with family health insurance coverage through an employer ($5,373.67 annually).
2. Michigan
Michigan’s score: 6.37 out of 100
Michigan emerges as the second most affordable state for healthcare. Its key metrics include:
- Michigan residents pay the lowest annual premium for both plus-one health insurance coverage ($3,475.67) and family health insurance coverage ($4,703) through an employer.
- The state also boasts the fourth lowest health insurance premium for those with silver plans in the Affordable Care Act marketplace ($354.33 annually).
- Michigan has the fifth lowest annual deductible for both family health insurance coverage ($3,350.33) and single health insurance coverage ($1,687.33) through an employer.
- It also ranks sixth lowest for the percentage of adults reporting 14 or more mentally unhealthy days a month who could not see a doctor due to cost (16.8%).
3. Washington
Washington’s score: 11.51 out of 100
Washington State claims the third spot as the most affordable state for healthcare, trailing just 5.14 points behind Michigan on our index scale. The Evergreen State has these key metrics:
- The state boasts the second lowest average premium for residents with family health insurance coverage through an employer ($5,320 annually).
- Washington holds the fourth lowest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (5.9%).
- It also offers the fourth lowest average premium for residents with plus-one health insurance coverage through an employer ($3,758 annually).
- The state features the fifth lowest average premium for residents with single health insurance coverage through an employer ($1,240.33 annually).
- Washington ranks ninth for the lowest health insurance premium for those with silver plans in the Affordable Care Act marketplace ($389 annually).
4. California
California’s score: 32.13 out of 100
California secures its position as the fourth most affordable state for healthcare with several key metrics reflecting its lower healthcare costs:
- The state has the sixth lowest average deductible for residents with single health insurance coverage through an employer ($1,741.33 annually).
- California is home to the seventh lowest percentage of adults reporting 14 or more mentally unhealthy days a month who could not see a doctor due to cost (17%).
- It also claims the seventh lowest percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months (6.1%).
- The state boasts the eighth lowest average premium for residents with single health insurance coverage through an employer ($1,443.33 annually).
5. Massachusetts
Massachusetts’ score: 32.96 out of 100
Coming in fifth on our list of least expensive states for healthcare is Massachusetts. The state has lower healthcare costs in these critical areas:
- Massachusetts has the sixth lowest percentage of adults who chose not to see a doctor at some point in the past 12 months due to cost (7.5%).
- It features the ninth lowest average premium for residents with plus-one health insurance coverage through an employer ($3,815.33 annually).
- The state also boasts the 10th lowest average deductible for residents with single health insurance coverage through an employer ($1,798.67).
- Additionally, Massachusetts has the 11th lowest health insurance premium for those with silver plans in the Affordable Care Act marketplace ($392.67 annually).
Tips to Reduce Healthcare Costs
When it comes to healthcare costs, a proactive approach can make all the difference. Understanding what health insurance is and how to navigate the system can help you secure the best health insurance that fits your budget and needs. Here are some practical tips to keep those bills at bay.
Firstly, shop around for the best affordable health insurance. Don't settle on the first plan you come across. Take the time to get health insurance quotes from multiple providers. This will give you a clearer picture of how much health insurance costs and what you can expect in terms of coverage.
Next, if you’re wondering how to get health insurance that’s right for you, start by assessing your health needs and risks, then look for a plan that addresses those directly. This will require you to consider what health insurance covers and what it doesn’t. Choose a plan that matches your health needs to avoid paying for unnecessary coverage.
If you're nearing retirement age, focus on finding the best health insurance for seniors. Plans designed for seniors often provide coverage that’s aligned with the common health concerns and needs that arise later in life. This can help you cut down on healthcare costs in the long run.
Remember, the largest health insurance companies aren’t always the best choice for everyone. Sometimes, smaller providers offer more tailored plans that could be more cost-effective for your situation.
Lastly, don’t overlook the consequences of not having health insurance. Going without coverage can result in hefty out-of-pocket costs for medical services and emergencies. Investing in health insurance can help offer financial security should you get sick or require surgery in the future.
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Methodology
To determine which states are the most (and least) expensive for healthcare, we compared all 50 states and Washington, D.C. across the following nine metrics:
- Average annual premium for employees with single coverage through employer-provided health insurance: 15% of score. Data comes from KFF. For this metric we took a three-year average, using data from 2020 to 2022.
- Average annual premium for employees with plus one coverage through employer-provided health insurance: 15% of score. Data comes from KFF. For this metric we took a three-year average, using data from 2020 to 2022.
- Average annual premium for employees with family coverage through employer-provided health insurance: 15% of score. Data comes from KFF. For this metric we took a three-year average, using data from 2020 to 2022.
- Average annual deductible for employees with family coverage through employer-provided health insurance: 15% of score. Data comes from KFF. For this metric we took a three-year average, using data from 2020 to 2022.
- Average annual deductible for employees with single coverage through employer-provided health insurance: 15% of score. Data comes from KFF. For this metric we took a three-year average, using data from 2020 to 2022.
- Average individual health insurance premium for a silver tier health plan: 10% of score. Data comes from KFF. For this metric we took a three-year average, using data from 2022 to 2024.
- Percentage of adults who chose not to see a doctor at some point in the past 12 months due to cost: 7% of score. Data comes from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. For this metric we took a three-year average, using data from 2020 to 2022.
- Percentage of adults reporting 14 or more mentally unhealthy days a month who could not see a doctor at some point in the past 12 months due to cost: 4% of score. Data comes from Mental Health America, 2020.
- Percentage of children whose families struggled to pay for their child’s medical bills in the past 12 months: 4% of score. Data comes from KFF, 2022.
