November 2022 – By Les Masterson-
Health care costs averaged over $10,000 per person in 2020, but the exact amount varied by state. We compared all 50 states and the District of Columbia across 11 key metrics using data from the Kaiser Family Foundation to determine which states are most and least expensive for health care.
- South Dakota topped the list of states with the most expensive health care, while Michigan is the cheapest.
- Forbes Advisor’s analysis found that the eastern part of the country is where you may find the most expensive health care costs. Five of the 10 most expensive states for medical care are in the east, including West Virginia, Florida, Maine, Delaware and New Hampshire.
- The western part of the country has many of the cheapest states for health care, including Washington, Nevada, Hawaii, New Mexico and Oregon.
- 44% of Americans consider a medical bill of under $1,000 to be unaffordable.
- In an effort to reduce costs in the past 12 months, 27% of survey respondents have delayed a doctor’s visit, 19% have delayed a medical procedure, and 19% have avoided a prescription refill.
Top 5 States Where Health Care Is Most Expensive
1. South Dakota
South Dakota’s score: 100 out of 100
- The families of 12% of children in South Dakota struggled to pay for their child’s medical bills between 2019 and 2020, making the state tied for fourth highest in the nation for this metric. Only Wyoming, Florida and Texas were higher. Nebraska, Kansas and Indiana were tied with South Dakota.
- The Mount Rushmore State also ranked ninth highest for health care costs per person in the state, with South Dakota health care costs averaging $11,736 per year for services, such as hospital care, doctor’s visits, nursing home care and prescription medications.
- South Dakota also had the third highest increase in overall health care spending per person over a five-year period (24.38%). Only New York and Hawaii saw bigger jumps.
- South Dakota had the sixth highest annual health insurance premium for those with individual plans in the Affordable Care Act marketplace ($7,156) and the third highest annual health insurance deductible for employer-provided insurance among those with single coverage ($2,428).
Louisiana’s score: 86.69 out of 100
- Louisiana residents with employer-provided health insurance pay some of the highest premiums in the nation. The average single employee spends an average $1,740 per year (the sixth highest amount in the nation). Employees with “plus one” coverage pay $4,685 (the highest in the nation) and employees with a family plan pay $6,999.67 annually (the second highest in the nation).
- Louisiana had the fifth highest increase in overall health care spending per person between 2016 and 2020 (23.10%). Only New York, Hawaii, South Dakota and California saw a bigger hike.
3. West Virginia
West Virginia’s score: 82.31 out of 100
- West Virginians with individual health insurance from the Affordable Care Act marketplace paid the fourth highest annual health insurance premiums in the nation ($8,024).
- The state ranked seventh highest in the country for overall health care spending per person ($12,019).
- West Virginia residents have experienced the eighth highest increase in per capita health spending over a five-year period: West Virginians spent 21.75% more on health care in 2020 than they did in 2016.
Florida’s score: 79.51 out of 100
- The families of 14% of children in Florida had difficulty paying for their child’s health care bills between 2019 and 2020, ranking second highest in the nation for this metric, only behind Wyoming.
- Floridians with employer-provided family health coverage pay the highest annual premium in the nation ($7,079.33), and residents with one additional person on their employer-based health plan pay the second highest annual premium in the nation ($4,684.67), behind only Louisiana.
- The cost of health insurance is also causing Florida residents to skip seeing the doctor. Florida residents were fifth most likely to report that they did not see a doctor in the past 12 months due to cost (14.87%). Among the 1,056,000 Florida adults who reported an unmet need for mental health treatment in 2020, 51.9% did not receive care because of cost, ranking sixth highest for this metric.
Wyoming’s score: 78.63 out of 100
- Wyoming residents with an individual health insurance plan from the Affordable Care Act marketplace paid the highest annual premium in the nation ($9,620). That’s $1,400 more than the second highest average cost (Alaska).
- The families of 16% of children in Wyoming had trouble paying for their child’s medical bills between 2019 and 2020, ranking highest in the nation for this metric.
- Wyoming also had the highest share of adults who reported an unmet need for mental health treatment due to cost . Of the 33,000 Wyomingites who reported an unmet need for mental health treatment in 2020, 64.7% did not receive care due to cost.
Top 5 States Where Health Care Is Least Expensive
Michigan’s score: 0 out of 100
- Michigan’s five-year increase in health care spending per person (13.67%) was the sixth lowest in the nation behind only the District of Columbia, North Carolina, Nevada, Wisconsin and Vermont.
- Michigan residents who have employer-provided health insurance pay some of the lowest premiums and deductibles in the nation. The average employee with plus one coverage in Michigan pays an average premium of $3,261.33 a year and employees with a family plan pay $4,199.67 a year (both the lowest averages in the country).
- Michiganders with family health coverage through an employer have the third lowest average deductible in the country ($3,078.67 a year) and single employees have the fifth lowest deductible ($1,675.67 a year).
- Michigan residents with individual health insurance plans from the Affordable Care Act marketplace have the fourth lowest average annual premium ($4,092 a year). Only Minnesota, Rhode Island and New Hampshire residents pay lower premiums for health plans from the ACA marketplace.
Washington’s score: 1.93 out of 100
- Washington residents with employer-provided health insurance pay some of the lowest premiums in the nation. The average employee with single coverage spends an average of $1,139.67 a year (the third lowest nationwide). Employees with “plus one” coverage pay an average $3,388.67 (the second lowest) and those with a family plan pay $5,121.67 annually (the second lowest).
- Washington has the fourth lowest ranking among states for the percentage of children whose families had trouble paying for a child’s medical bills in the past 12 months (6%).
- The state also had the 10th lowest increase in a five-year increase in health care spending per person (14.43%). That’s almost half of the cost increase seen in the states that saw the biggest jump (New York and Hawaii).
Nevada’s score: 18.21 out of 100
- Nevada ranks fourth in the nation for the lowest health care expenditures per capita, with Nevada health care costs averaging $8,118 per year. Only Utah, Idaho and Texas had lower per person health care costs.
- Nevada had the third lowest increase in overall health care spending per person over a five-year period (13.16%) behind only the District of Columbia and North Carolina.
- The health care numbers weren’t all positive for Nevada. The state had the 11th highest percentage of adults who delayed care over the past 12 months because of cost (13.3%).
Hawaii’s score: 21.19 out of 100
- Adults in Hawaii were least likely in the nation to report skipping a doctor’s visit in the past 12 months due to cost (7.10%).
- Hawaiians with employer-provided health insurance with single coverage pay the lowest average premiums in the country ($846.67 a year). Hawaii is the only state with average premiums for single coverage under $1,000 a year.
- Hawaiians with coverage through work have the lowest average deductibles for single coverage ($1,280.67) and family coverage ($2,812.33).
- Only 5% of children’s families struggled to pay for their child’s medical bills in Hawaii between 2019 and 2020, ranking second lowest in the nation for this metric (Hawaii tied with Rhode Island).
47. New Mexico
New Mexico’s score: 29.60 out of 100
- New Mexico residents with individual health plans from the Affordable Care Act marketplace pay the fifth lowest average premium in the nation ($4,096 a year). Only Minnesota, Rhode Island, New Hampshire and Michigan have cheaper average premiums.
- New Mexico adults were among the least likely in the nation to report an unmet need for mental health treatment in the past year due to cost (25.9%), ranking fourth lowest in the nation for this metric. Only Massachusetts, Connecticut and South Carolina had lower percentages.
- New Mexico had the ninth cheapest health care expenditures per person ($8,505 a year average).
Health Costs Leading to Debt and Delayed Care
Health care costs result in medical debt and even cause some Americans to put off doctor visits, medical procedures and prescription drug refills.
Forbes Advisor surveyed 2,000 U.S. adults about how health care costs impact them. We found that 23% are paying off medical debt and many people in that situation have made lifestyle changes in the past 12 months to help pay off that debt.
Many Americans with medical debt say they’ve made life changes to pay off the debt over the past 12 months, including:
- 16% lived on a tighter budget and purchased cheaper items
- 9% canceled or postponed travel plans
- 8% delayed home improvement projects
- 6% put off saving for retirement
Adjusting spending habits is still not enough, as many believe medical debt will remain with them for years. Though most people with medical debt (61%) expect to pay off their debt in the next two years, 39% don’t think they’ll pay off their medical debt for at least three years.
The cost of health care is also forcing many Americans to put off doctor appointments and medical procedures.
In an effort to reduce costs in the past 12 months:
- 27% delayed doctor appointments
- 19% put off a medical procedure
- 19% didn’t refill a prescription
- 18% pushed back a physical exam
- 15% delayed mental health treatment
Many Americans consider a medical bill of under $1,000 to be unaffordable
A person’s financial situation can influence whether they face crippling medical debt. One person may think a $500 medical bill is no big deal, while someone with limited income may have no way to pay that bill.
Nearly half (44%) of Americans surveyed say a medical bill under $1,000 is unaffordable. That includes 26% who say that a medical bill of $500 or less would be unaffordable.
How are Americans paying expensive medical bills? Most people who are faced with a medical bill of $500 or more are putting it on credit and debit cards or using multiple ways to pay the debt.
- 40% put it on a credit card
- 30% have it on a debit card
- 26% have an installment plan with a hospital or other provider
- 16% tapped into emergency savings
- 12% borrowed money from a friend or family member
Health insurance availability affects career choices
Health care costs are not only putting people into debt. They’re also influencing our job selections.
Most people who are pre-retirement age get health insurance through an employer and many Americans select a job for the health coverage. Forbes Advisor’s survey found that 31% of people with employer-provided health insurance stayed at a job they disliked because of the company’s health coverage and 20% chose to work full-time rather than part-time to get health insurance.
Health insurance can help a company retain—or lose—employees. Our survey found that 8% of respondents with health insurance through work said they left a job that they liked because they wanted better health coverage.
Inflation impacts health insurance selections during open enrollment
Health insurance open enrollment is the time of year when you can choose or make changes to your health insurance. Inflation is playing a part in which health plan people select this year.
Our survey found that 23% of American adults say they will select a plan with a lower premium because of inflation, while 11% will choose a plan with a lower deductible because of inflation. Another 7% plan to use a health savings account to help offset inflationary costs.
Health Care Costs Study Methodology
To measure the most and least expensive states for health care, Forbes Advisor examined data from the Kaiser Family Foundation for all 50 states and the District of Columbia and compared it across 11 metrics:
- Health care expenditures per capita: 20% of score. This metric includes out-of-pocket spending on all privately and publicly funded personal health care services and products such as hospital care, physician services, nursing home care and prescription drugs. We took a three-year average using data from 2018 to 2020.
- Percent of state residents who did not see a doctor in the past 12 months due to cost: 15% of score. For this metric, we took a three-year average using data from 2018 to 2020.
- Average individual health insurance premium for a Silver tier health plan: 10% of score. For this metric, we took a three-year average using data from 2020 to 2022.
- Average annual single premium per enrolled employee for employer-provided health insurance: 5% of score. For this metric, we took a three-year average using data from 2019 to 2021.
- Average annual plus one premium per enrolled employee for employer-sponsored health insurance: 5% of score. For this metric, we took a three-year average using data from 2019 to 2021.
- Average annual family premium per enrolled employee for employer-provided health insurance: 10% of score. For this metric, we took a three-year average using data from 2019 to 2021.
- Average annual deductible per enrolled employee for family coverage: 5% of score. For this metric, we took a three-year average, using data from 2019 to 2021.
- Average annual deductible per enrolled employee for single coverage: 5% of score. For this metric, we took a three-year average, using data from 2019 to 2021.
- Percent increase in out-of-pocket health care expenditure by state over a five year period: 15% of score. For this metric we calculated the five-year percent increase in health care spending from 2016 to 2020.
- Percent of adults reporting unmet need for mental health treatment in the past year who did not receive care because of cost: 5% of score. Data for this metric is from 2019 to 2020.
- Percent of children whose families struggled to pay for their child’s medical bills in the past 12 months: 5% of score. Data for this metric is from 2020.
To see how Americans are being impacted by the high cost of health care, the Forbes advisor team commissioned an online survey of 2,000 American adults, which was conducted by market research company OnePoll, in accordance with the Market Research Society’s code of conduct. Surveys were conducted from Oct. 28 to Nov. 1, 2022. The margin of error is +/- 2.2 points with 95% confidence. The OnePoll research team, a member of the MRS and has a corporate membership with the American Association for Public Opinion Research (AAPOR), oversaw the survey.
Les Masterson- Les is an insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Besides covering insurance, Les was a news editor and reporter for Patch and Community Newspaper Company and also covered health care, mortgages, credit cards and personal loans for multiple websites.
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