Best and Worst States for Healthcare in 2026: Rankings by Cost, Outcomes and Access

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The state you live in shapes how long and how well you live. A child born in Hawaii can expect to live 79.9 years. A child born in Mississippi can expect to live 70.9 years, a full nine years less.

Health insurance costs vary just as widely. Maryland residents pay $477 a month for the ACA benchmark silver plan. Vermont residents pay $1,223 per month, 2.6 times the cost of comparable coverage in Maryland.

MoneyGeek evaluated every state and Washington, D.C., across 14 metrics that measure health outcomes, costs and access. These 2026 healthcare rankings by state show which state health systems perform and which fall short.

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KEY FINDINGS
  • The Spending Disconnect: West Virginia spends $12,769 per person on healthcare, more than 45 other states, yet ranks 50th overall. Its cost performance score is 0, the lowest in the country, even though it places in the top 10 for access.
  • The Health Outcome Gap: Nine years separate Hawaii's life expectancy (79.9) from Mississippi's (70.9). Mississippi's all-cause mortality rate (995.4 per 100,000) is 69% higher than Hawaii's (587.8). Connecticut's diabetes mortality rate (39.4 per 100,000) is roughly one-third of West Virginia's (117.9).
  • The Regional Divide: Twelve of the bottom 15 states are in the South. Four of the top 10 are in the Northeast. The divide comes down to specific policy choices: Medicaid expansion status and the partisan split in uninsured rates.
  • Cost and Outcomes Don’t Track Together: New York spends $14,007 per person, second-highest in the country, but still ranks 23rd overall. A high outcomes score (95.7) isn't enough to make up for a cost score of 15.4. Washington leads on cost performance (100), with a $557 monthly ACA benchmark premium.
  • Coverage Alone Isn’t Enough: Washington, D.C., has near-universal coverage (97.3%) and the highest provider density nationally (177.2 primary care physicians per 100,000 residents). The district still ranks fourth overall because its health outcomes score (59.1) trails the top performers. High provider availability doesn't overcome concentrated urban inequality.
  • What the Top State Gets Right: Hawaii ranks first overall with an 87.6 final score. It scores 100 on outcomes, 89.1 on cost performance and 73.8 on access. No single score pulls the average down.

By the Numbers: America’s Healthcare Divide

Life Expectancy

Hawaii (79.9 years)

Mississippi (70.9 years)

9 years

All-Cause Mortality

Hawaii (587.8 per 100,000)

Mississippi (995.4 per 100,000)

69% higher
ACA Silver Premium

Maryland ($477)

Vermont ($1,223)

2.6 times the cost
Diabetes Mortality

Connecticut (39.4 per 100,000)

Oklahoma (172.2 per 100,000)

4.37 times the rate
Infant Mortality

New Hampshire (3.1 per 1,000)

Mississippi (8.9 per 1,000)

2.9 times the rate
Uninsured Rate

Massachusetts (2.6%)

Texas (16.3%)

6.3 times the rate

Provider Density

Washington, D.C. (177.2 per 100,000)

Utah (60.2 per 100,000)

2.9 times the density

Top 10 States for Healthcare

The top-ranked states share clear strengths: high coverage rates, sufficient primary care capacity, competitive premiums relative to income and lower mortality. Long-term public health investment shows in their scores across all three pillars.

1

Hawaii

87.6

100

89.1
73.8
2

New Hampshire

82.1
86.9
93.1
66.2
3

Massachusetts

79.9
99.2
65.1
75.5
4

Washington, D.C.

79.3
59.1
78.7

100

5

Minnesota

76.7
76.9

85

68.3
6

New Jersey

75

98.6
73.1
53.3
7

Washington

74.9
78.7

100

46.2
8

Colorado

74.7
83.1
93.1
47.8
9

Rhode Island

74.6
73.7
81.7
68.3
10

North Dakota

72

68.4
69.4
78.2

Bottom 10 States for Healthcare

At the bottom of the rankings, states deal with overlapping problems: higher obesity and smoking rates, higher mortality, lower coverage and fewer primary care providers per capita.

Rural geography means longer travel times and fewer specialists. Higher poverty rates mean more coverage gaps and higher rates of unmanaged chronic disease, a pattern MoneyGeek found in earlier research on uninsured Americans. 

The combined effect drags scores down even where premiums or spending are moderate.

51

Alaska

27.8
48.5
6.9

28

50

West Virginia

28.9
21.1

0

65.6
49

Mississippi

29.9

0

49.8
39.8
48

Oklahoma

30.9
13.1
54.8
24.9
47

Arkansas

35.2
19.5

41

45.2
46

Texas

35.6

56

51.1

0

45

Georgia

36.9
43.7
43.5
23.4
44

Tennessee

40.4
28.5
50.7
42.1
43

Wyoming

41.2
65.5
17.8
40.3
42

Alabama

44.4
26.2

57

50

Regional Healthcare Patterns

State performance across outcomes, cost and access reflects policy choices, local demographics and geographic conditions.

NORTHEAST: STRONG POLICY FRAMEWORKS AND DENSE PROVIDER NETWORKS

Average Final Score: 67.6

Four of the top 10 states are in the Northeast, a region with broad insurance coverage, strong provider supply and decades of public investment in health access.

Where the Northeast Performs Well

  • Four of the top five states nationally for primary care provider density
  • Massachusetts and Vermont in the top five for coverage rates nationally
  • Outcomes scores above 70 in four of the five highest-ranked Northeast states

Where the Northeast Lags

  • Vermont ($1,223) and New York ($1,154) have the two highest premiums in the country
  • New York ($14,007 per person) ranks second-highest nationally for per capita health spending
SOUTH: POLICY GAPS AND HIGHER DISEASE BURDENS

Average Final Score: 46.

The South accounts for 12 of the bottom 15 states.

Contributing Factors

  • Higher uninsured rates
  • Higher obesity and chronic disease rates
  • Limited primary care capacity

State-Level Patterns

  • Mississippi, Alabama, Louisiana and Arkansas rank lowest for outcomes
  • Tennessee, Kentucky and Oklahoma score below 30 on outcomes
  • West Virginia's cost performance score is 0, the lowest in the country, with outcomes ranked near the bottom as well
WEST: HIGH VARIATION AND GEOGRAPHIC CONSTRAINTS

Average Final Score: 60.4

Hawaii ranks first nationally at 87.6 while Alaska ranks last at 27.8, giving the West a wider performance spread than any other region.

Regional Leaders

  • Hawaii ranks first overall at 87.6
  • Washington ranks first on cost performance (100)
  • Colorado posts an outcomes score of 83.1 and a cost performance score of 93.1

Geographic Constraints

  • Alaska's geographic isolation pushes costs higher
  • Wyoming's premiums exceed $1,100
  • Montana, Idaho and Nevada have rural provider shortages
MIDWEST: UNEVEN PERFORMANCE ACROSS THE REGION

Average Final Score: 61.2

Most Midwestern states rank between 20th and 40th nationally.

Where the Midwest Performs Well

  • Most Midwestern states post premiums below the national average
  • Hospital bed capacity exceeds the national average across most of the region

Where the Midwest Lags

  • Missouri, Indiana and Kansas post higher mortality rates
  • Ohio's mortality rate ranks 42nd nationally
  • Rural areas have far fewer primary care providers than urban centers

Additional Findings: Category Rankings

Lowest All-Cause Mortality Rates (per 100,000)

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Top 5

  1. Hawaii: 587.8
  2. New York: 610.5
  3. New Jersey: 629.6
  4. California: 644.6
  5. Minnesota: 692.8
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Bottom 5 (Highest Mortality)

  1. Mississippi: 995.4
  2. West Virginia: 972.9
  3. Oklahoma: 961.4
  4. Alabama: 959.5
  5. Arkansas: 948.9

Lowest ACA Marketplace Premiums (Monthly Benchmark Silver Premiums)

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Top 5

  1. Maryland: $477
  2. New Hampshire: $482
  3. Idaho: $542
  4. Washington: $557
  5. Indiana: $564
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Bottom 5 (Most Expensive Premiums)

  1. Vermont: $1,223
  2. New York: $1,154
  3. Wyoming: $1,114
  4. West Virginia: $1,089
  5. Alaska: $1,040

Highest Insurance Coverage Rates (% of Residents Insured)

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Top 5

  1. Massachusetts: 97.4%
  2. Washington, D.C.: 97.3%
  3. Hawaii: 97.2%
  4. Vermont: 96.6%
  5. Minnesota: 96%
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Bottom 5 (Lowest Coverage, Highest Uninsured Rates)

  1. Texas: 16.3% uninsured
  2. Georgia: 12% uninsured
  3. Oklahoma: 11.4% uninsured
  4. Florida: 10.5% uninsured
  5. Mississippi: 10.5% uninsured

Most Primary Care Providers (per 100,000 Residents)

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Top 5

  1. Washington, D.C.: 177.2
  2. Vermont: 123
  3. Massachusetts: 118.1
  4. Maine: 115.1
  5. Rhode Island: 110.4
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Bottom 5

  1. Utah: 60.2
  2. Nevada: 63.4
  3. Oklahoma: 64.4
  4. Idaho: 68.1
  5. Texas: 76

Best Cost Performance Scores

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Top 5

  1. Washington: 100
  2. Idaho: 99.2
  3. Maryland: 97.4
  4. Colorado: 93.1
  5. New Hampshire: 93.1
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Bottom 5 (Lowest Cost Performance Scores)

  1. West Virginia: 0
  2. Alaska: 6.9
  3. Vermont: 12.6
  4. New York: (15.4)
  5. Wyoming: 17.8

Lowest Health Outcomes Pillar Scores

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Bottom 5

  1. Mississippi: 0
  2. Oklahoma: 13.1
  3. Arkansas: 19.5
  4. Kentucky: 19.8
  5. West Virginia: 21.1
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Top 5 (Best Outcomes)

  1. Hawaii: 100
  2. Massachusetts: 99.2
  3. New Jersey: 98.6
  4. New York: 95.7
  5. Connecticut: 87.3
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Methodology

MoneyGeek scored all 50 states and Washington, D.C., across three equally weighted pillars:

  • Outcomes: Mortality, life expectancy, obesity and smoking
  • Cost: Premiums, spending levels and cost performance
  • Access: Coverage, hospital bed supply and primary care capacity

MoneyGeek's scoring framework uses consistent metrics to produce a final score from 0 to 100 for each state and jurisdiction.

The 14 Metrics MoneyGeek Used

Outcomes:

  • All-cause mortality (2023, CDC WONDER)
  • Infant mortality (2023, CDC WONDER)
  • Diabetes mortality (2023, CDC WONDER)
  • Life expectancy (2021, CDC NCHS via KFF)
  • Adult obesity rate (2023, CDC BRFSS via KFF)
  • Adult smoking rate (2023, CDC BRFSS via KFF)

Cost:

  • ACA premiums (2026, MoneyGeek)
  • Commonwealth Fund performance index (2025)
  • Health spending as a share of GDP (2020, BEA/KFF)
  • Per capita health spending (2020, BEA/KFF)

Access:

  • Insurance coverage (2024, Census/KFF)
  • Hospital beds per 1,000 residents (2023, AHA)
  • Primary care providers per 100,000 residents (2022, AMA/KFF)
  • Primary care shortage areas, share of need met (2024–2025, HRSA)

How MoneyGeek Calculated Final Scores

MoneyGeek converted each metric to a Z-score, applied importance weights and rescaled each pillar to a 0 to 100 scale, then averaged outcomes, cost and access equally to produce the final score.

Why Data Years Vary

Metrics update on different schedules. ACA premiums reflect 2026 data, while other measures update annually or every two years. MoneyGeek uses the most recent validated data for each measure.

Full Dataset

This table shows final scores and pillar breakdowns for all 50 states and Washington, D.C.

1
Hawaii
87.6

100

89.1
73.8
2
New Hampshire
82.1
86.9
93.1
66.2
3
Massachusetts
79.9
99.2
65.1
75.5
4

Washington, D.C.

79.3
59.1
78.7

100

5
Minnesota
76.7
76.9

85

68.3
6
New Jersey

75

98.6
73.1
53.3
7
Washington
74.9
78.7

100

46.2
8
Colorado
74.7
83.1
93.1
47.8
9
Rhode Island
74.6
73.7
81.7
68.3
10
North Dakota

72

68.4
69.4
78.2
11
California
71.6
90.5
73.7
50.8
12
Maryland
69.8
64.9
97.4

47

13
Iowa
67.8
63.8
79.9
59.7
14
Idaho
67.5
70.8
99.2
32.5
15
Oregon
67.2
71.2
73.9
56.4
16
Virginia
67.1
66.8
82.8
51.7
17
Connecticut
66.8
87.3
51.9
61.2
18
Utah
66.6
80.8
79.3
39.9
19
Illinois
65.5
67.8
72.9
55.7
20
Wisconsin
62.3
62.9
64.4
59.7
21
Pennsylvania
62.2
57.9
66.7

62

22
Michigan
62.1
52.6
69.3
64.2
23
New York
57.4
95.7
15.4
61.1
24
Maine
57.2
62.8
48.5
60.1
25
South Dakota
56.8
53.5
58.1
58.9
26
Montana
55.9
62.3
54.8
50.4
27
Ohio
55.8
40.3
69.8
57.5
28
Arizona
55.8
68.7
69.3
29.3
29
Nebraska
55.7
57.1
46.4
63.5
30
Indiana
55.4
41.7
72.9
51.6
31
Kansas

54

53.7
57.6
50.8
32
Vermont
53.4
70.2
12.6
77.3
33
Delaware
50.4

55

51.3
44.9
34
Missouri
49.8
48.9
54.8
45.7
35
Nevada
48.5
55.2
66.2
24.2
36
South Carolina
47.5
34.7
66.3
41.6
37
Florida
47.5
68.3
44.2

30

38
North Carolina
46.6

45

59.5
35.4
39
Kentucky
46.4
19.8
61.1
58.2
40
New Mexico
46.3
60.9
45.3
32.7
41
Louisiana
45.1
26.9
47.2
61.1
42
Alabama
44.4
26.2

57

50

43
Wyoming
41.2
65.5
17.8
40.3
44
Tennessee
40.4
28.5
50.7
42.1
45
Georgia
36.9
43.7
43.5
23.4
46
Texas
35.6

56

51.1

0

47
Arkansas
35.2
19.5

41

45.2
48
Oklahoma
30.9
13.1
54.8
24.9
49
Mississippi
29.9

0

49.8
39.8
50
West Virginia
28.9
21.1

0

65.6
51
Alaska
27.8
48.5
6.9

28

About Nathan Paulus

Nathan Paulus, Head of Content and SEO, MoneyGeek

Nathan Paulus is the Senior Director of Content and SEO at MoneyGeek, where he leads content strategy and conducts original data research across insurance, consumer costs, transportation safety, housing, public policy and personal finance. He reviews studies for methodology, source quality and factual accuracy.

Research and Analysis

In more than six years at MoneyGeek, Nathan has published more than 100 original studies and explanatory guides. His insurance research includes 50-state comparisons of health care outcomes, costs and access, and an analysis of how uninsured rates track with state Medicaid expansion decisions and electoral patterns. 

He has analyzed full-coverage auto rates across major insurers in all 50 states and tracked how premium trends relate to industry underwriting losses. That research draws on combined ratio data from Fitch Ratings and AM Best, plus the Bureau of Labor Statistics CPI figures. Beyond insurance, his work spans vehicle pricing trends across the U.S. new car market, summer traffic fatality rates by state, homeowner underinsurance ratios using mortgage and policy data, and housing affordability across all 50 states.

His research has been cited by Bloomberg, the Los Angeles Times, Forbes, Fast Company, the San Francisco Chronicle, USA Today and NBC Los Angeles. Harvard, MIT, Stanford and Yale have referenced his work.

Career

Nathan traces his interest in personal finance back to his grandmother, who ran her household on a simple rule: spend less than you make and save the difference before anything else. That rule shows up in his work today. His writing skips jargon and complex strategy in favor of the basics that help someone living paycheck to paycheck.

He joined MoneyGeek in July 2020 as Director of Content Marketing, where he led the content team and oversaw data journalism production across insurance and personal finance verticals. A promotion to Head of Marketing and Communications followed in December 2023. The new role added digital PR and communications strategy to his responsibilities. He was appointed Head of Content and SEO in January 2025.

Before MoneyGeek, Nathan served as Director of Content Marketing and SEO at Ventrix Advertising, where he helped build two content sites from scratch, contributed to link-building programs that generated more than 1,500 unique referring domains within a year and co-managed a marketing team of more than 20 people. Two and a half years at ABUV Media preceded that role. He advanced from Marketing Research Analyst to Senior Marketing Tactics Analyst, where he built expertise in audience research, content strategy and SEO.

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