State Health Affordability
How much does health care cost where you live? This view compares four affordability signals across all 50 states and D.C.: ACA marketplace insurance premiums, Medicare Part D drug spending, the share of adults carrying medical debt, and the rate at which insurers deny in-network claims.
Out-of-pocket costs, 1990–2022
What the average American pays directly for medical care each year — and how that burden has grown over three decades.
Per-capita out-of-pocket spending on health care (current dollars). Source: CMS National Health Expenditure Accounts. Values are nominal and have outpaced both inflation and wage growth over the period — meaning the typical household's medical bills take a larger bite of income today than they did three decades ago.
Compare by state
Sort any column or filter by state name. Medical-debt figures are exact for all 50 states and D.C. (Urban Institute Credit Bureau Panel, 2023).
| State | ACA Premium ↑ /mo, 2024 | Drug Cost /Part D enrollee, 2023 | Medical Debt % in collections, 2023 |
|---|---|---|---|
| New Hampshire | $335 | $4,542 | 1.9% |
| Minnesota | $343 | $4,081 | 0.3% |
| Maryland | $346 | $5,315 | 1.7% |
| Virginia | $371 | $4,841 | 0.8% |
| Michigan | $381 | $5,083 | 3.1% |
| Nevada | $387 | $4,273 | 6.9% |
| Indiana | $399 | $5,609 | 4.5% |
| Rhode Island | $400 | $4,627 | 0.0% |
| Arizona | $403 | $4,274 | 4.5% |
| Washington | $415 | $4,179 | 0.0% |
| Idaho | $417 | $4,317 | 2.6% |
| Massachusetts | $419 | $5,838 | 1.1% |
| Arkansas | $424 | $4,927 | 6.3% |
| Kentucky | $431 | $6,111 | 5.1% |
| Ohio | $435 | $5,126 | 4.4% |
| Pennsylvania | $445 | $5,238 | 2.6% |
| Colorado | $451 | $4,237 | 0.0% |
| Iowa | $451 | $4,545 | 2.3% |
| New Jersey | $461 | $5,952 | 1.5% |
| Georgia | $463 | $5,735 | 7.4% |
| California | $468 | $4,799 | 0.0% |
| Hawaii | $468 | $4,437 | 1.1% |
| New Mexico | $471 | $4,088 | 5.3% |
| Illinois | $473 | $4,944 | 0.0% |
| Texas | $475 | $5,196 | 7.6% |
| Wisconsin | $476 | $4,681 | 3.2% |
| Mississippi | $485 | $5,796 | 5.3% |
| Kansas | $486 | $4,654 | 3.4% |
| North Dakota | $486 | $3,969 | 1.9% |
| Oregon | $488 | $3,787 | 0.9% |
| Florida | $489 | $4,905 | 4.3% |
| South Carolina | $492 | $5,490 | 4.7% |
| North Carolina | $495 | $5,527 | 3.7% |
| Missouri | $501 | $5,179 | 4.8% |
| Tennessee | $501 | $5,457 | 7.9% |
| Montana | $504 | $3,875 | 3.8% |
| Utah | $507 | $4,067 | 2.3% |
| Oklahoma | $508 | $5,614 | 8.7% |
| Maine | $515 | $5,138 | 5.0% |
| District of Columbia | $532 | $6,965 | 1.0% |
| Delaware | $533 | $5,529 | 5.7% |
| Louisiana | $563 | $5,960 | 6.8% |
| Alabama | $564 | $6,031 | 5.9% |
| Nebraska | $570 | $4,804 | 2.1% |
| South Dakota | $616 | $4,211 | 1.1% |
| Connecticut | $661 | $6,410 | 0.9% |
| New York | $736 | $6,885 | 0.0% |
| Wyoming | $821 | $4,012 | 8.5% |
| West Virginia | $847 | $5,898 | 5.6% |
| Alaska | $889 | $5,784 | 5.8% |
| Vermont | $950 | $5,134 | 0.0% |
Showing 51 states. Color scale: dark green = best, dark red = worst (lower is better for all four metrics).
Medical Debt Burden
Share with medical debt in collections (Urban Institute, 2023)
Seven states (CA, CO, IL, NY, RI, VT, WA) report 0.0% — medical debt does not appear in credit-bureau collections, reflecting state restrictions on medical-debt credit reporting.
Urban Institute, Debt in America 2025 (Credit Bureau Panel). Full data available on their site.
Claim Denial Rates
Avg. in-network denial rate, HealthCare.gov insurers (2024)
KFF analysis of CMS Transparency in Coverage Public Use Files. Full data available on their site.
Methodology & sources
ACA premium — 2024 average monthly benchmark (second-lowest-cost silver) premium for a 40-year-old, weighted by county plan selections. Source: KFF, "Average Marketplace Premiums by Metal Tier," 2024.
Drug cost — 2023 average gross drug cost per Medicare Part D enrollee (overall, including both stand-alone PDP and MA-PD). Source: KFF analysis of CMS Program Statistics — Medicare Part D. Reflects the Medicare (65+) population and is not a measure of retail drug prices for all ages.
Medical debt — Share of people with any medical debt in collections appearing on credit reports, by state (2023). Source: Urban Institute, "Debt in America 2025" — State-Level Medical Debt, derived from the Urban Institute Credit Bureau Panel. Seven states (CA, CO, IL, NY, RI, VT, WA) report 0.0%, reflecting state laws that restrict medical-debt credit reporting; the national figure is the 51-state mean. This measures debt in collections on credit files, which is narrower than survey-based medical-debt estimates.
Denial rate — Average in-network claim denial rate for qualified health plans sold on HealthCare.gov in 2024. Source: KFF analysis of CMS Transparency in Coverage Public Use Files. State-based marketplaces (CA, NY, WA, CO, etc.) are not included because they do not use HealthCare.gov.
Disclaimer: For educational and informational purposes only. This dashboard aggregates publicly available data from IRS Form 990 filings and third-party sources; figures may be incomplete, estimated, or out of date. Nothing here constitutes legal, financial, tax, or medical advice, or an endorsement or judgment of any organization or individual. Always verify with official filings and qualified professionals before relying on any figure.