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

Featured Experts:

EG
 Eduardo Grunvald
Jay Bhatt - headshotJB
 Jay Bhatt
Cyrena Gawuga - headshotCG
 Cyrena Gawuga
Rima Cohen - headshotRC
 Rima Cohen
Tracey Brigman - headshotTL
 Tracey Brigman, Ed.D., M.S., RDN, LD
TP
 Tinglong Dai, Ph.D.
AP
 Allie Peckham, MSW, Ph.D.
RM
 Reena Kelly, Ph.D., MHA
Raymond March - headshotRP
 Raymond March, PhD
Chunhuei Chi - headshotCS
 Chunhuei Chi, ScD
Dr. Brandon Di Paolo Harrison - headshotBP
 Brandon Di Paolo Harrison, PhD
LK
 Luba Ketsler
+ 9 more experts

Advertising & Editorial Disclosure

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 per month for ACA silver benchmark coverage. Vermont residents pay $1,223 per month, or 2.6 times more for similar coverage.

MoneyGeek evaluated every state and Washington, D.C., across 14 metrics that measure health outcomes, costs and access to care. These 2026 health care rankings by state show which systems perform and which don't.

mglogo icon
KEY FINDINGS
  • The Spending Disconnect: West Virginia spends $12,769 per person on health care, more than 45 other states, but ranks 50th overall. The state has the lowest cost performance score in the country (0) despite top-10 access.
  • The Health Outcome Gap: A nine-year life expectancy gap separates the best and worst performers. 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 gap tracks regional policy differences, including Medicaid expansion decisions and the partisan divide in uninsured rates.
  • Cost and Outcomes Don’t Track Together: New York spends $14,007 per person, the second-highest nationally, but ranks only 23rd overall. Strong outcomes (95.7) don't offset high costs (15.4). Washington posts the highest cost performance score (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) lags the top performers. High availability doesn't overcome concentrated urban inequality.
  • What Success Looks Like: Hawaii ranks first overall with an 87.6 final score. It posts high scores across outcomes (100), cost performance (89.1) and access (73.8). No single pillar holds it back.

By the Numbers: America’s Health Care 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 higher
Provider Density
Washington, D.C. (177.2 per 100,000)
Utah (60.2 per 100,000)
2.9 times more

Top 10 States for Health Care

States at the top of MoneyGeek's rankings share a recognizable pattern: high insurance coverage rates, sufficient primary care capacity, competitive premiums relative to income and lower mortality. States in this group have invested in public health over time, and that investment shows up across outcomes, cost and access scores.

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 Health Care

Lower-performing states show consistent weaknesses: higher obesity and smoking rates, higher mortality, lower insurance coverage and fewer primary care providers per capita. Rural geography creates longer travel times and fewer specialists. Areas with higher poverty rates report more coverage gaps and higher rates of unmanaged chronic disease. MoneyGeek documented this pattern in earlier research on uninsured Americans. These conditions pull down overall scores even when premiums or spending levels 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 Health Care 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. The region benefits from broad insurance coverage, provider supply and long-standing policy commitment to access.  

Where the Northeast Performs Well

  • Dense primary care networks
  • High insurance coverage
  • Strong outcomes

Where the Northeast Lags

  • Vermont ($1,223) and New York ($1,154) have the two highest premiums in the country
  • Per capita spending in several Northeast states exceeds $12,000
SOUTH: POLICY GAPS AND HIGHER DISEASE BURDENS

Average Final Score: 46.

The South anchors the bottom of the rankings.  

Contributing Factors

  • Higher uninsured rates
  • Higher obesity and chronic disease burdens
  • 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 pairs the lowest cost performance score with weak outcomes
WEST: HIGH VARIATION AND GEOGRAPHIC CONSTRAINTS

Average Final Score: 60.4

The West has the widest performance range of any region.

Regional Leaders

  • Hawaii ranks first overall
  • Washington leads on cost performance
  • Colorado scores well on outcomes and holds below-average costs

Geographic Constraints

  • Alaska's geographic isolation pushes costs higher
  • Wyoming's premiums exceed $1,100
  • Montana, Idaho and Nevada contend with 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

  • Premiums are moderate relative to the national average
  • Hospital bed capacity ranks above 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)

blueCheck icon

Top 5

  1. Hawaii: 587.8
  2. New York: 610.5
  3. New Jersey: 629.6
  4. California: 644.6
  5. Minnesota: 692.8
blueCheck icon

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)

blueCheck icon

Top 5

  1. Maryland: $477
  2. New Hampshire: $482
  3. Idaho: $542
  4. Washington: $557
  5. Indiana: $564
blueCheck icon

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)

blueCheck icon

Top 5

  1. Massachusetts: 97.4%
  2. Washington, D.C.: 97.3%
  3. Hawaii: 97.2%
  4. Vermont: 96.6%
  5. Minnesota: 96%
blueCheck icon

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)

blueCheck icon

Top 5

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

Bottom 5

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

Best Cost Performance (Cost Performance Score)

blueCheck icon

Top 5

  1. Washington: 100
  2. Idaho: 99.2
  3. Maryland: 97.4
  4. Colorado: 93.1
  5. New Hampshire: 93.1
blueCheck icon

Bottom 5 (Lowest Cost Performance Scores)

  1. West Virginia: 0
  2. Alaska: 6.9
  3. Vermont: 12.6
  4. Oklahoma: 54.8
  5. Wyoming: 17.8

Weakest Health Outcomes (Outcomes Pillar Score)

blueCheck icon

Bottom 5

  1. Mississippi: 0
  2. Oklahoma: 13.1
  3. Arkansas: 19.5
  4. Kentucky: 19.8
  5. West Virginia: 21.1
blueCheck icon

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
Loading...

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 (2023, CDC BRFSS via KFF)
  • Adult smoking (2023, CDC BRFSS via KFF)

Cost:

  • ACA premiums (2026, MoneyGeek)
  • Commonwealth Fund performance index (2025)
  • Health spending as a percent 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 percent need met (2024 to 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. MoneyGeek then averaged the three pillars (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
57.0
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 Head of Content and SEO at MoneyGeek, where he leads content strategy and produces original data research across insurance, consumer costs, transportation safety, housing, public policy and personal finance. He also reviews published studies for methodology, source quality and factual accuracy before they reach readers.

Research and Analysis

In nearly six years at MoneyGeek, Paulus has published more than 100 original studies and explanatory guides. His insurance research includes 50-state comparisons of health care outcomes, costs and access; an analysis of how uninsured rates track with state Medicaid expansion decisions and electoral patterns; full coverage auto rate analyses across major insurers in all 50 states; and a study of how premium trends track with industry underwriting losses, with combined ratio data sourced from Fitch Ratings, AM Best and Bureau of Labor Statistics CPI figures. His research also covers 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 also referenced his work.

Career

Growing up, Paulus developed an early interest in personal finance through his grandmother, who emphasized saving over earning as the foundation of financial stability. Her framing still shows up in how he writes about money for people without a financial background.

Paulus joined MoneyGeek in July 2020 as Director of Content Marketing. In that role, he led the content team and directed data journalism production across insurance and personal finance verticals. He was promoted to Head of Marketing and Communications in December 2023, where he took on digital PR and communications strategy. He has held his current role as Head of Content and SEO since January 2025.

Before MoneyGeek, he served as Director of Content Marketing and SEO at Ventrix Advertising. There, he helped build two content sites from scratch, contributed to link-building programs that secured more than 1,500 unique referring domains within a year, and co-managed a marketing team of more than 20 people. Earlier, he spent two and a half years at ABUV Media, moving up from Marketing Research Analyst to Senior Marketing Tactics Analyst, where he built his grounding in audience research, content strategy and SEO.

Read Full Bio »
Sources