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 the District of Columbia 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. High spending doesn't guarantee results. West Virginia has the lowest cost performance score in the country (0.0) 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. These patterns align with 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. Positive outcomes (95.7) don’t offset high costs (15.4). Washington reaches the highest cost performance score (100.0) while maintaining 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). It still ranks fourth overall because health outcomes (59.1) remain moderate. Health care availability doesn’t overcome concentrated urban inequality.
  • What Success Looks Like: Hawaii ranks first overall with an 87.6 final score. It performs well across outcomes (100.0), cost performance (89.1) and access (73.8). Consistency across all pillars drives Hawaii’s lead.

By the Numbers: America’s Health Care Divide

Life Expectancy
Hawaii 79.9 years
Mississippi 70.9 years
9.0 years
All-Cause Mortality
Hawaii 587.8 per 100k
Mississippi 995.4 per 100k
69% higher
ACA Silver Premium
Maryland $477
Vermont $1,223
2.6 times the cost
Diabetes Mortality
Connecticut 39.4 per 100k
Oklahoma 172.2 per 100k
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
DC 177.2 per 100k
Utah 60.2 per 100k
2.9 times more

Top 10 States for Health Care

Top-performing states share several strengths: high insurance coverage, primary care capacity, competitive premiums relative to income and lower mortality rates. They maintain stable health infrastructure and long-term public health investment. Their results reflect how states are ranked by health care quality when outcomes, cost performance and access reinforce one another.

These states achieve the best overall balance of outcomes, cost performance and access in MoneyGeek’s 2026 rankings. Readers can compare their state’s results using the full rankings table below.

1
87.6
100.0
89.1
73.8
2
82.1
86.9
93.1
66.2
3
79.9
99.2
65.1
75.5
4
79.3
59.1
78.7
100.0
5
76.7
76.9
85.0
68.3
6
75.0
98.6
73.1
53.3
7
74.9
78.7
100.0
46.2
8
74.7
83.1
93.1
47.8
9
74.6
73.7
81.7
68.3
10
72.0
68.4
69.4
78.2

Bottom 10 States for Health Care

Lower-performing states face challenges across multiple 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 often face more coverage gaps and more unmanaged chronic disease, consistent with national patterns in Americans who remain uninsured. These factors weaken results even when premiums or spending levels seem moderate.

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

51
27.8
48.5
6.9
28.0
50
28.9
21.1
0.0
65.6
49
29.9
0.0
49.8
39.8
48
30.9
13.1
54.8
24.9
47
35.2
19.5
41.0
45.2
46
35.6
56.0
51.1
0.0
45
36.9
43.7
43.5
23.4
44
40.4
28.5
50.7
42.1
43
41.2
65.5
17.8
40.3
42
44.4
26.2
57.0
50.0

Regional Health Care Patterns

Regional patterns show how policy choices, demographics and geography shape performance across outcomes, cost performance 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: 46.0

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 20.0 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 shows the widest range of performance.

Success Stories

  • Hawaii ranks first
  • Washington leads cost performance
  • Colorado maintains solid outcomes with 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

These rankings show which states perform best and worst on individual metrics that drive the 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. Wyoming: $1,114
  3. Alaska: $1,040
  4. West Virginia: $1,089
  5. New York: $1,154

Highest Insurance Coverage Rates (% of Residents Insured)

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Top 5

  1. Massachusetts: 97.4%
  2. District of Columbia: 97.3%
  3. Hawaii: 97.2%
  4. Vermont: 96.6%
  5. Minnesota: 96.0%
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Bottom 5 (Lowest Coverage, Highest Uninsured Rates)

  1. Texas: 16.3% uninsured
  2. Georgia: 12.0% uninsured
  3. Florida: 10.5% uninsured
  4. Oklahoma: 11.4% uninsured
  5. Mississippi: 10.5% uninsured

Most Primary Care Providers (per 100,000 Residents)

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Top 5

  1. District of Columbia: 177.2
  2. Vermont: 123.0
  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: 76.0

Best Cost Performance (Cost Performance Score)

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Top 5

  1. Washington: 100.0
  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: 0.0
  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: 0.0
  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: 100.0
  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 the District of Columbia 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

This framework provides a clear way to compare health care quality across states using consistent metrics. Each state receives a final score from 0 to 100.

The 14 Metrics We 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 We Calculated Final Scores

We converted each metric to a Z-score, applied importance weights, rescaled pillars to a 0 to 100 scale and averaged them equally. This provides a standardized way to evaluate states ranked by health care quality.

Why Data Years Vary

Different metrics update on different schedules. ACA premiums reflect 2026 data, while other measures update annually or biannually. We use the most recent validated data for each measure.

Full Dataset

This table shows final scores and pillar breakdowns for all 50 states and the District of Columbia. Readers can compare their state's performance across outcomes, cost and access

1
Hawaii
87.6
100.0
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
District of Columbia
79.3
59.1
78.7
100.0
5
Minnesota
76.7
76.9
85.0
68.3
6
New Jersey
75.0
98.6
73.1
53.3
7
Washington
74.9
78.7
100.0
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
72.0
68.4
69.4
78.2
11
California
71.6
90.5
73.7
50.8
12
Maryland
69.8
64.9
97.4
47.0
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
62.0
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
54.0
53.7
57.6
50.8
32
Vermont
53.4
70.2
12.6
77.3
33
Delaware
50.4
55.0
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
30.0
38
North Carolina
46.6
45.0
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
50.0
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
56.0
51.1
0.0
47
Arkansas
35.2
19.5
41.0
45.2
48
Oklahoma
30.9
13.1
54.8
24.9
49
Mississippi
29.9
0.0
49.8
39.8
50
West Virginia
28.9
21.1
0.0
65.6
51
Alaska
27.8
48.5
6.9
28.0

About Nathan Paulus

Nathan Paulus headshot

Nathan Paulus is the Head of Content at MoneyGeek, where he conducts original data analysis and oversees editorial strategy for insurance and personal finance coverage. He has published hundreds of data-driven studies analyzing insurance markets, consumer costs and coverage trends over the past decade. His research combines statistical analysis with accessible financial guidance for millions of readers annually.

Paulus earned his B.A. in English from the University of St. Thomas, Houston.

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