Forbes Advisor on Tuesday released a list of the most—and least—expensive states for health care, with South Dakota ranked as the most expensive state and Michigan ranked as the least expensive.

Methodology

To create the list, Forbes Advisor analyzed Kaiser Family Foundation data from all 50 states and the District of Columbia to assign each state a score on a scale of zero (least expensive) to 100 (most expensive). Researchers measured the data across 11 metrics, which included:

• Health care expenditures per capita (20%), which included out-of-pocket spending on both privately and publicly funded personal health care services and products, which was measured as a three-year average using data from 2018 to 2020
• Percent of residents who skipped doctor visits in the past 12 months because of cost (15%), which was measured as a three-year average using data from 2018 to 2020
• Average individual premiums for Silver tier health insurance plans (10%), which was measured as a three-year average using data from 2020 to 2022
• Average annual single premium per employee for employer-provided health plans (5%), which was measured as a three-year average using data from 2019 to 2021
• Average annual plus one premium per employee for employer-sponsored health plans (5%), which was measured as a three-year average using data from 2019 to 2021
• Average annual family premium per employee for employer-provided health plans (10%), which was measured as a three-year average using data from 2019 to 2021
• Average annual deductible per employee with family coverage (5%), which was measured as a three-year average using data from 2019 to 2021
• Average annual deductible per employee with single coverage (5%) which was measured as a three-year average using data from 2019 to 2021
• Five-year percent increase in out-of-pocket health care expenditure, by state (15%), which was measured using health care spending data from 2016 to 2020
• Percent of adults who experienced an unmet need for mental health treatment in the last year who did not receive care due to cost (5%), which was calculated using data from 2019 to 2020
• Percent of children whose families struggled to cover their child's medical bills during the past 12 months (5%), which was calculated using data from 2020

To evaluate the impact of high health care costs, Forbes Advisor partnered with market research company OnePoll to conduct an online survey of 2,000 American adults from Oct. 28 to Nov. 1, 2022.

Which states are most (and least) expensive for health care?

According to the study, states in the eastern United States are typically more expensive. In fact, five of the 10 most expensive states for health care are on the east coast, including West Virginia, Florida, Maine, Delaware, and New Hampshire. 

Overall, the five most expensive states for health care are:

1. South Dakota, with a score of 100

2. Louisiana, with a score of 86.69

3. West Virginia, with a score of 82.31

4. Florida, with a score of 79.51

5. Wyoming, with a score of 78.63

In addition, the study found that states in the western United States were among the least expensive states for health care, with Washington, Nevada, Hawaii, New Mexico, and Oregon ranking low on the list of the most expensive states.

Overall, the five least expensive states for health care are:

51. Michigan, with a score of 0

50. Washington, with a score of 1.93

49. Nevada, with a score of 18.21

48. Hawaii, with a score of 21.19

47. New Mexico, with a score of 29.60

The impact of high health care costs

According to the study, 23% of respondents are paying off medical debt. During the past 12 months, many respondents reported making lifestyle changes to help pay off medical debt, including:

• Tightening their budget and purchasing less expensive items (16%)
• Canceling or delaying travel plans (9%)
• Postponing home improvement projects (8%)
• Delaying saving for retirement (6%)

High health care costs have also led many Americans to delay care. During the past 12 months, respondents reported:

• Delaying a doctor's visit (27%)
• Delaying a medical procedure (19%)
• Skipping a prescription refill (19%)
• Delaying a physical exam (18%)
• Postponing mental health treatment (15%)

Forbes Advisor found that 44% of Americans consider a medical bill that is less than $1,000 to be unaffordable—and 26% consider a medical bill of $500 or less to be unaffordable.

When faced with a medical bill of $500 or more, many people find alternative ways to cover the cost, including:

• Paying with a credit card (40%)
• Paying with a debit card (30%)
• Entering an installment plan with their provider (26%)
• Using emergency savings (16%)
• Borrowing money from friends or family members (12%)

This year, many Americans are considering inflation when selecting a health plan. The survey found that 23% of American adults said they will enroll in a health insurance plan with lower premiums due to inflation. Similarly, 11% said they will choose a plan with a lower deductible for the same reason. In addition, 7% said they plan to use a health savings account to help offset the rising costs triggered by inflation. (Masterson/Danise, Forbes Advisor, 11/8)