If you've ever felt the effects of health care costs, you're not alone. Unexpected medical bills and the cost of health care are two of Americans' top two financial concerns this year, according to a recent KFF health survey. The survey found that 45% of adults are very worried about whether they will be able to pay unexpected medical bills, and 39% are very worried about their ability to cover the cost of medical services.
These financial fears have real consequences. The high cost of health care is forcing some Americans to make tough choices - often to the detriment of their health. Nearly two in five adults ages 19 to 64 have delayed or skipped health care between 2022 and 2023 because they can't afford it, according to a study by the Commonwealth Fund. That includes putting off doctor visits, medical procedures and refilling prescription drugs.
However, the burden of health care costs is not evenly distributed across the country. In some states, residents face much higher health care costs, including higher premiums and deductibles, causing them to delay health care more often due to cost.
To shed light on where health care spending will be highest, our experts conducted an analysis comparing all 50 states and Washington, D.C. on nine key indicators. The results of this study show which states will have the highest health care spending in 2024 and which states will have the lowest.
Top 5 most expensive states for health care
North Carolina Assessment: 100 out of 100
North Carolina is the most expensive state for health care prices, with the highest average premiums for residents with "plus one" health insurance through an employer ($4,781 per year).
- North Carolina has the second highest average premium for residents with family health insurance through an employer ($7,180.33 per year).
- According to the state, this is the fifth-highest average deductible for residents with single health insurance through an employer ($2,267.67 per year).
- It has the 11th highest average deductible for residents with family health insurance through an employer ($4,061.67 per year).
2. South Dakota
South Dakota's score: 93.41 out of 100
South Dakota ranks second among the states with the highest health care prices. Here are the key statistics:
- South Dakota ranks fourth in the percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (11.9%).
- It also has the fourth highest average deductible here for residents with single health insurance through an employer ($2,433 per year).
- South Dakota has the fifth highest average deductible for residents with family health insurance through an employer ($4,330.67 per year).
- The state also has the sixth highest average premium for residents with "plus one" health insurance through an employer ($4,599.33 per year).
- In addition, South Dakota has the sixth highest health insurance premiums for those with silver plans in the Affordable Care Act marketplace ($596.67 per year).
3. Nebraska
Nebraska's score: 93.09 out of 100
Health care costs are also high in the Cornhusker State. Nebraska residents face these key indicators:
- The state ranks third in the percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (12.1%).
- Nebraska ranks seventh in annual health insurance premiums for both single person ($1,796.33) and plus one ($4,530.67) through an employer.
- It has the eighth highest average premium for residents with family health insurance through an employer ($6,766.33 per year).
- It also has the eighth-highest health insurance premium for those with silver plans on the Affordable Care Act marketplace ($570 per year).
4. Florida
Florida's score: 92.50 out of 100
Florida residents may enjoy no state taxes and plenty of sunshine, but they live in the state with the highest average premium for families.
- Florida has the highest average premiums for residents with family health insurance through an employer ($7,258 per year).
- Florida has the second highest average premiums for residents with "plus one" health insurance through an employer ($4,727.33 per year).
- Florida has the fourth highest percentage of adults who chose not to see a doctor 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 per month who could not see a doctor due to cost (30.1%).
- In addition, Florida ranks eighth in the percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (11.1%).
5. Texas
Texas' score: 91.38 out of 100
Following Florida is Texas, another state that many families flock to because of its affordability. If you live in the Lonestar State or are considering relocating, check out these key health statistics:
- Texas has the highest percentage of adults who chose not to see a doctor in the past 12 months because of cost (16%).
- It also has the highest percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (14.9%).
- Texas ranks third in the percentage of adults reporting 14 or more mentally unhealthy days per month who could not see a doctor due to cost (31.5%).
- The state ranks fourth in annual premiums for both health insurance plus one ($4,626) and family health insurance ($7,051.33) through an employer.
Top 5 most affordable states for health care
Hawaii's score: 0 out of 100
Hawaii is the benchmark for the most affordable healthcare in the US. Hawaii scored 0 on our health care cost rankings and boasts the lowest percentage and cost in several key metrics:
- Hawaii had the lowest percentage of adults who chose not to see a doctor in the past 12 months because of cost (5.7%).
- It also has the lowest percentage of adults reporting 14 or more mentally unhealthy days per month who could not see a doctor due to cost (11.6%).
- Hawaii has the lowest average premiums for residents with single health insurance through an employer ($911 per year).
- It also has the lowest average deductible here for residents with single health insurance through an employer ($1,310 per year).
- Hawaii has the second highest percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (5.7%).
- Hawaii residents with family health insurance through an employer pay the second highest average deductible ($3,115 per year).
- Hawaii has the third highest average premium for residents with "plus one" health insurance through an employer ($3,654.67 per year).
- Here is the fourth highest average premium for residents with family health insurance through an employer ($5,373.67 per year).
2. Michigan
Michigan's score: 6.37 out of 100
Michigan ranks second among the states for access to health care. Its key indicators include:
- Michigan residents pay the lowest annual premiums for both single-person health insurance ($3,475.67) and family health insurance ($4,703) through an employer.
- The state also boasts the fourth-highest health insurance premium for those with silver plans in the Affordable Care Act marketplace ($354.33 per year).
- Michigan has the fifth highest annual deductible for both family health insurance ($3,350.33) and single health insurance ($1,687.33) through an employer.
- It also ranks sixth in the percentage of adults reporting 14 or more mentally unhealthy days per month who could not see a doctor due to cost (16.8%).
3. Washington, D.C.
Washington's score: 11.51 out of 100
Washington State ranks as the third most affordable state for health care prices, trailing Michigan by just 5.14 points on our index. The Evergreen State has the following key metrics:
- The state boasts the second highest average premium for residents with family health insurance through an employer ($5,320 per year).
- Washington has the fourth highest percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (5.9%).
- It also has the fourth-highest average premium for residents with "plus one" health insurance through an employer ($3,758 per year).
- The state has the fifth highest average premium for residents with single health insurance through an employer ($1,240.33 per year).
- Washington has the ninth lowest health insurance premiums for those with silver plans in the Affordable Care Act marketplace ($389 per year).
4. California
California: 32.13 points out of 100
California continues to rank fourth among the states with the most affordable health care prices, with several key indicators reflecting declining health care costs:
- The state has the sixth highest average deductible for residents with single health insurance through an employer ($1,741.33 per year).
- California ranks seventh among adults reporting 14 or more mentally unhealthy days per month who are unable to see a doctor due to cost (17%).
- It also has the seventh highest percentage of children whose families had difficulty paying their child's medical bills in the past 12 months (6.1%).
- The state ranks eighth in average premium for residents with single health insurance through an employer ($1,443.33 per year).
5. Massachusetts
Massachusetts score: 32.96 out of 100
Fifth on our list of states with the lowest health care costs is Massachusetts. In this state, health care costs are lower in the following critical areas:
- Massachusetts has the sixth highest percentage of adults who chose not to see a doctor in the past 12 months because of cost (7.5%).
- Here is the ninth highest average premium for residents with employer-provided "plus one" health insurance ($3,815.33 per year).
- The state also boasts the 10th highest average deductible for residents with single health insurance through an employer ($1,798.67).
- Massachusetts also has the 11th lowest health insurance premiums for those with silver plans in the Affordable Care Act marketplace ($392.67 per year).
Tips for reducing health care costs
When it comes to health care costs, a proactive approach can make a difference. Understanding what health insurance is and how to navigate the system can help you find the best health insurance to fit your budget and needs. Here are some practical tips to help you keep your bills from becoming a problem.
First of all, store around for the best health insurance available. Don't settle for the first plan you find. Spend time getting health insurance quotes from multiple providers. This will give you a better idea of how much health insurance costs and what you can expect in terms of coverage.
If you're wondering how to get health insurance that's right for you, start by assessing your needs and health risks, and then look for a plan that directly meets those requirements. This will require you to consider what health insurance covers and what it doesn't. Choose a plan that fits your needs so you don't pay for unnecessary coverage.
If you are approaching retirement age, focus on finding the best health insurance for seniors. Plans designed for seniors often provide coverage that fits common end-of-life health issues and needs. This can help you reduce your health care costs in the long run.
Remember that the largest health insurance companies are not always the best choice for everyone. Sometimes smaller providers offer more customized plans that may be more cost-effective for your situation.
Finally, don't forget about the consequences of not having health insurance. Not having insurance can lead to huge medical expenses and emergencies. Investing in health insurance can help provide financial security if you become ill or need surgery in the future.
To determine which states have the most (and least) expensive health care, we compared all 50 states and Washington, D.C., on the following nine measures:
- Average annual contribution for employees with single coverage under employer-provided health insurance: 15% of the amount. Data obtained from KFF. For this indicator, we took a three-year average using data from 2020 through 2022.
- Average annual premium for employees with plus-one coverage under employer-provided health insurance: 15% of premium. Data obtained from KFF. For this metric, we took a three-year average using data from 2020 through 2022.
- Average annual premium for employees with family coverage through employer-provided health insurance: 15% of premium. Data obtained from KFF. For this metric, we took a three-year average using data from 2020 through 2022.
- Average annual deductible for employees with family coverage through employer-provided health insurance: 15% of. Data obtained from KFF. For this metric, we took a three-year average using data from 2020 through 2022.
- Average annual deductible for employees with single coverage under employer-provided health insurance: 15% of the amount. Data obtained from KFF. For this metric, we took a three-year average using data from 2020 through 2022.
- Average individual health insurance premium for a silver level health insurance plan: 10% of points. Data obtained from KFF. For this indicator, we took a three-year average using data from 2022 through 2024.
- Percentage of adults who chose not to see a doctor at some point in the past 12 months because of cost: 7% of the total. Data are from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. For this indicator, we took a three-year average using data from 2020 through 2022.
- Percentage of adults reporting 14 or more mentally unhealthy days per month who were unable to see a doctor at some point in the past 12 months due to cost: 4% of the total. Data are from Mental Health America, 2020.
- Percentage of children whose families had difficulty paying their child's medical bills in the past 12 months: 4% of the total. Data taken from KFF, 2022.