Where Does Your State Rank in Healthcare Costs? The Most (and Least) Expensive States for Care.

Healthcare costs vary widely across the U.S., with some states spending nearly twice as much per person as others. A recent analysis by Steno Health, using data from the Bureau of Economic Analysis and Federal Reserve Economic Data (FRED), ranked the states with the highest and lowest healthcare spending.

But high spending doesn’t always mean residents can afford care. In some states, healthcare consumes over 20% of the average income, putting a serious financial strain on families. Let’s break down why some states pay more than others—and what it means for you.

The Most Expensive States for Healthcare

According to the Steno Health study, the top five states with the highest healthcare spending per person are:

1.  Alaska – $11,813 per year
2.  South Dakota – $10,881 per year
3.  North Dakota – $10,494 per year
4. Massachusetts – $10,491 per year
5. Delaware – $10,301 per year

But raw spending doesn’t tell the full story. A more accurate way to measure affordability is to compare healthcare costs to average income.

For example, in Massachusetts, healthcare spending accounts for 12.41% of the average income, while in Delaware, it’s a staggering 16.3% (Steno Health). And in West Virginia, residents spend 20% of their income on healthcare, making it one of the least affordable states despite not being the highest in total spending.

 (Related: How to Avoid Surprise Medical Bills)

The Least Expensive States for Healthcare

On the other end of the spectrum, the five states with the lowest healthcare spending per person are:

1.  Utah – $6,213 per year
2. South Carolina – $6,677 per year
3.  Nevada – $6,703 per year
4.  Texas – $6,793 per year
5.  Idaho – $6,882 per year

However, low spending doesn’t always mean better affordability. States like Texas and Florida have lower per-person spending but some of the highest uninsured rates (KFF). When fewer people are insured, they often skip necessary care, which lowers spending but leads to worse long-term health outcomes.(Related: How to Find Affordable Healthcare If You’re Uninsured)

Why Are Some States More Expensive Than Others?

1.  Rural States Often Pay More

Rural states like Alaska, North Dakota, and South Dakota have higher costs because fewer hospitals and specialists drive up prices (National Rural Health Association). Many residents also travel long distances for care, increasing transportation and out-of-network costs.

2.  High-Income States Spend More—But That Doesn’t Mean It’s Affordable

States like Massachusetts and New York spend more on healthcare but also have higher incomes and better insurance coverage (U.S. Census Bureau). This means that while costs are high, they may be less burdensome compared to lower-income states like West Virginia, where healthcare costs take up a much larger share of income.

3. States with More Uninsured Residents Spend Less—But at a Cost

Texas and Florida have lower healthcare spending per person, but also some of the highest uninsured rates (KFF). This suggests many residents skip care altogether, which can lead to higher costs later when untreated conditions worsen.

How to Manage Healthcare Costs

Even in a high-cost state, there are ways to reduce your healthcare expenses:

Understand Your Insurance Coverage

• Make sure you know your deductible, copay, and out-of-pocket maximum to avoid unexpected expenses.
• Always choose in-network providers to prevent higher charges.
• Take advantage of preventive care benefits, like annual check-ups and screenings, which are often covered at no cost.
• Read our blog on Health Insurance Basics

Compare Healthcare Costs Before You Get Care

• Prices for medical procedures can vary significantly between providers. Before scheduling a procedure, use cost comparison tools from your insurer.
• Consider urgent care or telehealth services for non-emergency issues instead of a costly emergency room visit.
• If you’re paying out-of-pocket, ask about self-pay or cash discounts—many providers offer lower rates for uninsured patients.

Look for Community Health Programs

Massachusetts has a strong network of community health centers and financial assistance programs for those who qualify. Options to explore:

• Sliding scale clinics that adjust fees based on income
• Prescription assistance programs that help lower medication costs
• State-sponsored health plans for low- and middle-income residents

(Related: Get Help with Health Insurance Claim Denials)

The Bottom Line

Healthcare costs vary widely across the U.S., but what you pay depends on more than just where you live.

In high-cost states like Alaska and Massachusetts, residents often have higher incomes and better access to care. Meanwhile, in states like West Virginia or Delaware, healthcare spending takes up a much larger share of household income, making affordability a bigger issue.

Understanding these differences can help you make informed healthcare choices—and take steps to reduce your costs.

Need help navigating health care costs? Get started with an advocate here.