Best and Worst States for Health Care 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 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 protection.

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 identify which systems perform well and which fall behind.

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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 healthiest and least healthy states. 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 moderate 2026 ACA premiums.
  • 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 health outcomes (59.1) remain moderate. 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

Uninsured Rate
Massachusetts (2.6%)
Texas (16.3%)
6.3 times higher
Infant Mortality
New Hampshire (3.1 per 1,000)
Mississippi (8.9 per 1,000)
2.9 times the rate
Diabetes Mortality
Connecticut (39.4 per 100,000)
Oklahoma (172.2 per 100,000)
4.37 times the rate
Life Expectancy
Hawaii (79.9 years)
Mississippi (70.9 years)
9 years
Provider Density
Washington, D.C. (177.2 per 100,000)
Utah (60.2 per 100,000)
2.9 times more
ACA Silver Premium
Maryland ($477)
Vermont ($1,223)
2.6 times the cost
All-Cause Mortality
Hawaii (587.8 per 100,000)
Mississippi (995.4 per 100,000)
69% higher

Top 10 States for Health Care

Top-performing states share a consistent profile: high insurance coverage, primary care capacity, competitive premiums relative to income and lower mortality rates. They combine long-term public health investment with strong scores across all three pillars.

These states post the best overall balance of outcomes, cost performance and access in MoneyGeek's 2026 rankings. State-by-state results are available in the full rankings table below.

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 weaknesses across several areas. Many have 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, a pattern MoneyGeek has documented in research on Americans who remain uninsured. These conditions pull down overall scores even when premiums or spending levels are moderate.

These states rank lowest because of weaker outcomes, higher cost barriers, limited access or a combination of these challenges.

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

Regional Health Care Patterns

Policy choices, demographics and geography all shape how states perform across outcomes, cost and access.

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.

Strengths

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

Challenges

  • Vermont and New York have some of the highest premiums
  • Per capita spending often 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

Patterns

  • Mississippi, Alabama, Louisiana and Arkansas rank lowest for outcomes
  • Tennessee, Kentucky and Oklahoma score below 20 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 range of performance.

Success Stories

  • Hawaii ranks first
  • Washington leads cost performance
  • Colorado posts solid outcomes and low cost barriers

Geographic Barriers

  • Alaska’s isolation drives higher costs
  • Wyoming’s premiums exceed $1,100
  • Rural shortages challenge Montana, Idaho and Nevada
MIDWEST: MIDDLE-RANGE PERFORMANCE WITH POCKETS OF STRENGTH

Average Final Score: 61.2

Most Midwestern states rank between 20th and 40th.

Strengths

  • Moderate premiums
  • High hospital capacity

Challenges

  • Higher mortality in Missouri, Indiana and Kansas
  • Ohio’s mortality rate ranks 42nd
  • Rural access varies widely

Additional Findings: Category Rankings

Each table below ranks states on the individual metrics that feed into their overall scores.

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 (Lowest Provider Supply)

  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)

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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. Oklahoma: 54.8
  5. Wyoming: 17.8

Weakest Health Outcomes (Outcomes Pillar Score)

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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. Each state receives a final score from 0 to 100.

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, rescaled pillars to a 0 to 100 scale and averaged them equally. 

Why Data Years Vary

Different 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. State-by-state results cover outcomes, cost and access.

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 headshot

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.

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