These states have the highest health care costs

Story at a glance


  • Five of the top 10 most expensive states were in the eastern portion of the United States.


  • Louisiana was the second most expensive state for health care.


  • Michigan had the cheapest health care costs in the nation.


South Dakota has the highest health care costs in the nation, according to a new report from Forbes Advisor. Louisiana ranked second, followed by West Virginia, Florida and Wyoming.

Nebraska, Maine, Delaware, New Hampshire and Oklahoma rounded out the top ten most expensive states.

Although South Dakota is situated in the Midwest, the states with the highest health care costs tended to be in the eastern portion of the country.

Researchers used data from the Kaiser Family Foundation to create a score reflecting 11 metrics of health care affordability.


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Health care expenditures per capita — including out-of-pocket spending on all privately and publicly funded health care services — held the most weight in each state’s score. It also included costs of hospital care, physician services, and prescription drugs. The total reflected a three-year average of data collected between 2018 and 2020.

The average health care cost per person in South Dakota came in at $11,736, putting it ninth overall for personal health care costs. Nearly half of adults in the state reported not receiving care for a mental health treatment due to cost.

Between 2019 and 2020, 12 percent of families in the state reported struggling to pay for their child’s medical bills, tying the total with those seen in Nebraska, Kansas and Indiana. However, over 12 percent of families in Wyoming, Florida and Texas said they struggled with this financial hurdle.

Over a five-year period, South Dakota had the third highest increase in health care spending per person at 24.4 percent. It was outpaced only by New York and Hawaii.

When it comes to premiums and deductibles, the state had the third highest annual health insurance deductible for employer-provided insurance among those with single coverage. For those with individual plans in the Affordable Care Act market place, South Dakota ranked sixth for the highest annual health insurance premium.

South Dakota is one of just 12 states that has not expanded Medicaid under the Affordable Care Act, although the measure is on the ballot in the 2022 midterm election.

Louisiana ranks second for the most expensive health care in the country. Residents who have employer-sponsored coverage pay some of the highest premiums in the country, while between 2016 and 2020, the state had the fifth highest increase in overall health care spending per person.

Out of the top 10 most expensive states, residents spent the most on health care per capita in Delaware, totaling $12,294. In Florida, nearly 15 percent of adults reported not seeing a doctor due to health care cost concerns.

On the other end of the spectrum, Michigan had the cheapest health care, and was followed by Washington, Nevada, Hawaii, and New Mexico, respectively.

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