The Best and Worst States for Health Insurance in 2025

Overview

Finding affordable health insurance is not equally easy across the United States. While some states excel in coverage options, affordability, and access to providers, others struggle with higher costs and gaps in care. To help consumers and policymakers better understand the landscape, Healthcare Insider analyzed all 50 states plus the District of Columbia across three key categories: Cost, Access, and Quality.

Our comprehensive ranking reveals which states are leading the way and which are falling behind. Explore our methodology to learn more.

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Rank	State	Final Score	Quality	Cost	Access
1	Massachusetts	73.27	24.45	22.49	26.32
2	District of Columbia	67.20	19.32	19.97	27.91
3	Rhode Island	66.08	22.87	21.37	21.84
4	Iowa	64.31	19.23	22.68	22.40
5	Virginia	63.28	20.44	20.53	22.31
6	Minnesota	62.16	18.67	21.00	22.49
7	New Jersey	61.97	26.60	19.60	15.77
8	New Hampshire	61.79	21.28	18.85	21.65
9	Maryland	61.23	18.76	21.37	21.09
10	Illinois	61.23	23.24	17.08	20.91
11	North Dakota	59.73	17.36	23.15	19.23
12	Hawaii	59.55	14.28	24.92	20.35
13	Connecticut	59.17	23.61	14.37	21.19
14	Pennsylvania	58.71	21.28	22.21	15.21
15	Nebraska	58.05	20.07	15.03	22.96
16	Colorado	56.56	21.09	15.49	19.97
17	Maine	56.56	18.20	18.20	20.16
18	New York	56.47	23.80	15.87	16.80
19	Montana	56.00	20.63	23.24	12.13
20	Wisconsin	55.91	18.67	18.95	18.29
21	California	54.88	19.51	16.89	18.48
22	Michigan	54.69	15.59	19.13	19.97
23	Ohio	54.23	16.33	16.99	20.91
24	Idaho	50.87	20.72	19.04	11.11
25	Missouri	50.21	14.65	14.84	20.72
26	Utah	49.93	20.72	14.65	14.56
27	Kansas	49.65	16.05	14.37	19.23
28	Oregon	49.65	17.83	16.61	15.21
29	Washington	49.56	17.64	18.57	13.35
30	Florida	48.53	21.47	12.04	15.03
31	Vermont	48.35	15.96	13.25	19.13
32	Tennessee	47.13	15.03	13.72	18.39
33	Nevada	46.29	14.84	19.51	11.95
34	Delaware	46.20	14.56	16.43	15.21
35	Kentucky	45.73	14.93	15.40	15.40
36	South Dakota	44.80	12.13	15.40	17.27
37	Louisiana	44.24	16.52	16.05	11.67
38	Wyoming	44.05	18.48	16.05	9.52
39	Indiana	43.03	10.73	15.49	16.80
40	Texas	41.91	17.17	11.48	13.25
41	Mississippi	41.53	10.83	15.12	15.59
42	Arizona	40.41	11.57	13.72	15.12
43	Alabama	40.13	11.01	14.93	14.19
44	Arkansas	39.39	11.01	17.92	10.45
45	Alaska	38.83	11.01	16.52	11.29
46	Georgia	38.83	10.92	13.07	14.84
47	Oklahoma	38.64	11.57	16.05	11.01
48	South Carolina	37.05	14.09	13.07	9.89
49	West Virginia	36.03	10.45	11.85	13.72
50	North Carolina	34.16	13.72	10.83	9.61
51	New Mexico	30.99	5.41	10.92	14.65

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COST

Average Annual Deductible per Enrolled Employee
Best: Pennsylvania
Worst: South Dakota

Personal Health Care Spending Per Capita
Best: Massachusetts
Worst: Mississippi

Average Employer Premiums
Best: District of Columbia
Worst: Wyoming

Share of Adults with Medical Debt
Best: Massachusetts
Worst: West Virginia

Cost of Insurance as % of Median Monthly Household Income
Best: Hawaii
Worst: Mississippi

Hospital Expenses per Adjusted Inpatient Day
Best: Utah
Worst: New York

High Out-of-Pocket Costs (%)
Best: Massachusetts
Worst: Louisiana

QUALITY

Community Hospitals Supported by Employer Insurance Payments Per Capita
Best: Florida
Worst: Rhode Island

Premature Deaths (Preventable & Treatable Causes)
Best: Massachusetts
Worst: West Virginia

Average Life Expectancy
Best: Hawaii
Worst: Mississippi

Hospital Safety (% A Grade)
Best: Utah
Worst: Wyoming

Youth Depression Without Mental Health Services (%)
Best: District of Columbia
Worst: South Dakota

Maternal Mortality Rate per 100,000 Live Births
Best: Massachusetts
Worst: Mississippi

Hospital Beds per 1,000 Population
Best: District of Columbia
Worst: Washington

ACCESS

Residents Covered by Employer Insurance Per Capita
Best: Utah
Worst: New Mexico

Workers in Companies Offering Insurance (%)
Best: Hawaii
Worst: Wyoming

Workers in Companies Offering a Choice Among Plans (%)
Best: District of Columbia
Worst: North Dakota

Internal Medicine Physicians per Capita
Best: District of Columbia
Worst: Mississippi

Hospitals Per Capita
Best: South Dakota
Worst: Maryland

Nurse Practitioners Per Capita
Best: District of Columbia
Worst: Hawaii

Adults Who Report Not Seeing a Doctor in the Past 12 Months Because of Cost (%)
Best: Hawaii
Worst: Pennsylvania

Methodology

Healthcare Insider compared 50 states plus the District of Columbia across three equally weighted categories: Cost, Access, and Quality. Each category was evaluated using 21 metrics listed above. Each metric was graded on a 100-point scale, with 100 representing the best possible outcome. States’ weighted averages across all metrics determined their final scores and rankings.

Category Definitions and Metrics

Access – Total Points: 33.33

Primary Care Providers per 100,000 residents: Full Weight
Residents Covered by Employer Insurance: Full Weight
Workers in Companies Offering Insurance (%): Full Weight
Workers in Companies Offering a Choice Among Plans (%): Full Weight
Total Hospitals Per Capita: Full Weight
Total Nurse Practitioners Per Capita: Full Weight
Adults Who Report Not Seeing a Doctor in the Past 12 Months Because of Cost: Full Weight

Cost – Total Points: 33.33

Average Deductible in Employer Plans: Full Weight
Personal Health Care Spending by State Per Capita: Full Weight
Average Employer Premiums: Full Weight
Share of Adults with Medical Debt, by State: Full Weight
Cost of Insurance as % of Median Monthly Household Income: Full Weight
Hospital Expenses per Adjusted Inpatient Day: Full Weight
High Out-of-Pocket Costs (%): Full Weight

Quality – Total Points: 33.33

Community Hospitals Supported by Employer Insurance Payments Per Capita: Full Weight
Rates of Premature Deaths from Preventable and Treatable Causes: Full Weight
Life Expectancy: Full Weight
Hospital Satisfaction – Patient Ratings: Full Weight
Youth Depression Without Mental Health Services (%): Full Weight
Maternal Mortality Rate per 100,000 Live Births: Full Weight
Hospital Beds per 1,000 Population by Ownership Type: Full Weight

Data Sources include: Kaiser Family Foundation (KFF), AHIP (America’s Health Insurance Plans), U.S. Health System Tracker, Commonwealth Fund, USAFacts, Leapfrog Hospital Safety Grade, Mental Health America (MHA).

Health Insurance FAQ

When can I enroll in a health insurance plan?
For ACA marketplace coverage, you can sign up during the Open Enrollment Period each year or qualify for a Special Enrollment Period if you experience a life change like losing coverage, moving, or turning 26. If you don’t qualify, you may consider short-term health plans, which can be purchased year-round, though they often provide limited benefits and may not cover pre-existing conditions.

Where can I learn more about health insurance options in my state?
To explore what’s available where you live, check out health insurance options by state. This section breaks down state-specific plans, marketplace details, and regulatory differences.

What should I consider when choosing a health insurance company?
When evaluating providers, it’s important to compare best health insurance companies by coverage area, customer satisfaction, network size, premiums, and plan variety.

How can I estimate financial help for ACA / marketplace plans?
Use the ACA subsidy calculator to see if you qualify for premium tax credits under the Affordable Care Act. These subsidies can lower monthly premiums based on your income and household size.

What are my alternatives if ACA marketplace plans are too expensive or I don’t qualify for subsidies?
There are several marketplace healthcare alternatives, such as short-term health plans, supplemental insurance, fixed-benefit medical plans, or faith-based health sharing ministries.

How can I compare insurer quality and find detailed reviews of health insurers?
For in-depth guidance, check out the insurer reviews section, which covers provider ratings, plan strengths and weaknesses, and how different insurers perform across states.

Why It Matters

Health insurance access and affordability remain pressing issues for millions of Americans. Where you live can determine not only how much you pay for coverage, but also how easy it is to access care and what health outcomes you can expect.

This study highlights states that excel in providing accessible, affordable, and high-quality health insurance and identifies where significant challenges remain. For consumers, the findings provide a benchmark when considering coverage options. For policymakers, they point to strategies that can close the gaps between top and bottom performers.

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