Vital Signs: Best States for Healthcare 2021

Is your state one of the best states for healthcare in terms of health insurance, healthcare costs and other key factors? Use these tools to compare your state against other states.
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COVID-19 tested the U.S. healthcare system like nothing in the past century. As new peaks in COVID cases place even further strains on that system, some states are better positioned than others to rise to the challenge.

The MoneyRates annual analysis of healthcare in the United States takes on added significance this year because of the continuing pandemic. Factors like existing health status, health insurance coverage, hospital costs, nursing home staffing and capacity of doctor’s offices will have a lot to do with how people in each state weather the crisis.

This year’s annual Vital Signs healthcare rankings found stark contrasts between certain states:

  • A resident of Texas is six times as likely as one of Massachusetts to lack health insurance
  • People in West Virginia are almost twice as likely as those in the District of Columbia to describe themselves as being in fair or poor health
  • Children in Georgia are more than twice as likely as those in Massachusetts to go without immunizations
  • The infant mortality rate in Mississippi is 2.4 times that in New Hampshire
  • Relative to the size of the elderly population, nursing facilities in Alaska have less than one-seventh the staffing of those in North Dakota
  • The ratio of doctors to state population is more than twice as high in Connecticut as in Hawaii
  • The cost of a daily hospital stay is more than 2.5 times as high in Washington state as in Mississippi
  • The average annual health insurance premium in Alaska is nearly $2,900 more than in Arkansas

Best States for Healthcare 2021: Methodology

Using data from the US Census Bureau, the Centers for Disease Control and the Kaiser Family Foundation, MoneyRates ranked each state’s performance in the following eight categories:

  1. Health insurance coverage – based on the percentage of each state’s population covered by health insurance.
  2. Reported health status – based on the percentage of each state’s population that reported their health status to be no better than “fair” or “poor.”
  3. Child immunization coverage – based on the percentage of young children in each state who had been immunized.
  4. Infant mortality rates – based on the percentage of births in each state to survive their first year.
  5. Adequacy of nursing care staffing – based on the number of nursing care employees compared to each state’s population aged 65 or older, a key metric for finding the states with the best healthcare for seniors.
  6. Adequacy of medical office staffing – based on the number of doctors’ office employees relative to each state’s population.
  7. Hospital affordability – based on the average cost of a day of inpatient care in each state.
  8. Health insurance affordability – based on the average cost of health insurance premiums in each state.

MoneyRates ranked each of these categories and then based the overall rankings on the average of rankings across all categories.

MoneyRates also classified state-by-state conditions in each category the way you might describe a person’s health:

  • Robust – the best 20 percent
  • Healthy – the next 20 percent
  • Average – the middle 20 percent
  • Frail – the next 20 percent
  • Critical condition – the bottom 20 percent

Healthcare Conditions in the U.S

Compare Healthcare Conditions in Each State

The color-coded map shows the overall assessment of healthcare in each state. Click on a state to show each of the categories that make up the overall assessment below.

Compare Up to Three States

Explore and compare the healthcare conditions in other states. To view a side-by-side comparison of up to three states, select a state from the map or the dropdown menu below. Click “Reset” to clear all and start over.

The 10 Best States for Healthcare 2021

The following ranked as the ten best states for healthcare:

1. Iowa

After ranking fourth in last year’s study, Iowa improved to number one with top-ten rankings in four of eight categories. Iowa was below the median state in just one category, ranking 40th for the staffing of doctors’ offices relative to the size of its population.

2. Massachusetts

After finishing first in each of the prior two annual studies, Massachusetts remains very strong this year. It ranks first in health insurance coverage and child immunization, and in the top ten in three other categories. Cost is the only drawback – Massachusetts is one of the ten most expensive states for both hospital stays and health insurance premiums.

3. (tie) Nebraska

Following two consecutive sixth-place finishes, Nebraska improved three places this year. Nebraska ranked in the top ten in four categories: reported health status, child immunization, nursing care staffing and health insurance affordability.

3. (tie) North Dakota

This is the second consecutive third-place ranking for North Dakota. The state has the highest concentration of nursing care staff relative to its elderly population and ranked in the top ten in three other categories as well.

5. Connecticut

Like neighboring Massachusetts, Connecticut has been a top-ten finisher in all three years of this study. It ranks first in the ratio of doctors’ office staff to total population and in the top ten in three other categories.

6. Rhode Island

Edging up one slot from last year, Rhode Island boasts top-ten rankings for health insurance coverage, nursing care staffing and doctors’ office staffing.

7. New Hampshire

The last of four New England states to make the top ten, New Hampshire moves up from eleventh place in each of the prior two studies. New Hampshire has the country’s lowest infant mortality rate, which may be due in part to having the third highest childhood immunization rate.

8. Virginia

This ranking is an example of the importance of consistency. While Virginia ranked in the top ten for just one category (childhood immunization), it was better than median in six other categories to rank eighth overall.

9. Maryland

While not a spectacular performer in any one category, Maryland earned a top ten overall ranking by finishing among the top 15 in four categories: health insurance coverage, health status, child immunization and doctors’ office staffing.

10. Kentucky

Though Kentucky ranked near the bottom for self-reported health status, this was overcome by top-15 rankings in five categories: health insurance coverage, nursing care capacity, doctors’ office staffing, hospital affordability and health insurance affordability.

Sort States by Healthcare Condition

In the chart below, you can see how each state ranked overall and look at its status in terms of individual categories. This is where you’ll begin to see the differences in healthcare from state to state.

Though the default sort is by state (ranked by overall condition), you can sort on any column to explore that aspect of healthcare.

For example, if you’re interested to learn where the most affordable healthcare premiums are, you can move the slider to the right side of the chart and sort the results on the Annual Healthcare Premium column.

Which state has the best child-immunization coverage? Click on the column heading to sort that column.

The 10 Worst States for Healthcare 2021

Here are the states that didn’t fare as well in this year’s study, listed from the worst on up to the tenth-worst:

1. South Carolina

This was the second consecutive year South Carolina ranked as the worst state for healthcare, and the year before that it was next to last. South Carolina performed worse than the median state in six out of eight categories, including ranking second to last for child immunization.

2. Oklahoma

This is the third year for this study, and Oklahoma has been in the bottom ten all three years. With rankings among the bottom ten in five different categories, it’s easy to see why.

3. Alaska

With its extremely cold temperatures and far-flung population, Alaska faces special healthcare challenges. Not surprisingly then, it’s been among the bottom ten in all three years of this study. It ranks worst out of all states for both the amount of nursing care staff relative to its elderly population and health insurance affordability.

4. New Mexico

Healthcare staffing seems to be a particular problem in New Mexico. The state ranked 49th for both the level of nursing care staff relative to its elderly population and the level of doctors’ office staff relative to the overall population.

5. Texas

This state has the lowest percentage of health insurance coverage (81.6%) and performed worse than the median state in six other categories.

6. Georgia

The biggest deficiency for Georgia in this study was ranking last for child immunization. It also didn’t help that the state ranked 49th in health insurance coverage.

7. Arizona

Bottom ten rankings in three categories (health insurance coverage, child immunization and nursing care staffing) were enough to drag Arizona into the bottom ten overall.

8. California

Though California deserves some credit for having the fifth-lowest infant mortality rate in the country, a shortage of medical staff (ranked 48th per capita) and high hospital costs (more expensive than everywhere except the state of Washington) result in a low overall ranking.

9. North Carolina

This is the same overall ranking North Carolina had last year. The biggest shortcoming was a bottom-ten finish in percentage of the population covered by health insurance.

10. Nevada

The three biggest problems for Nevada in this study were bottom ten rankings for health insurance coverage, nursing care staffing and doctors’ office staffing.

How to Manage Healthcare Costs

As this study shows, getting good healthcare is affected by where you live. It also depends on how well you can afford the cost of healthcare. Below are some tips for managing your healthcare costs.

1. Match health insurance with your needs

Everyone should have some health insurance to cover them in case major healthcare issues arise. The type of coverage you need depends on your health and your habits.

A healthy person who rarely visits a doctor may be better off with a high-deductible healthcare plan. These won’t cover routine expenses, but those expenses should be minimal for someone who makes few visits to the doctor. The payoff is that the insurance premiums will be lower while you will still have a safety net in case of a major setback.

However, someone in poorer health may want more comprehensive coverage. The premiums may cost more, but it should reduce out-of-pocket expenses for medical treatment.

2. Know what your plan covers

Don’t feel secure just because you have health insurance. Find out if it will really cover you for major expenses. Also, it helps to know your coverage before you start making healthcare appointments.

Besides knowing what kind of treatments are covered, be prepared for your policy’s deductible. This determines the amount you have to cover out of pocket before the insurance coverage kicks in. You should also be aware of any caps on the amount of expenses covered because these could leave you exposed if medical costs really mount up.

3. Have money set aside for out-of-pocket expenses

Don’t get caught short when it comes time to pay for medical treatment. Running up credit card debt will only add to the high cost of that treatment.

While having an emergency fund of savings can help, for many people a health savings account (HSA) is an even better idea. An HSA is only available if you are part of a high-deductible health care plan; but if you are, it allows you to put money for medical expenses aside tax-free.

A recent MoneyRates survey found that just over a quarter of respondents would be able to tap into one form of savings or another if they were confronted with an unexpected medical bill of $1,000 to $5,000. Unfortunately, though, nearly as many respondents said they would have to resort to some form of borrowing to pay that kind of bill.

Borrowing only compounds the cost of unexpected medical expenses. Setting aside savings in an emergency fund or HSA allows you to minimize the cost and put the situation behind you more quickly.

4. Use your HSA to augment retirement savings

Your HSA can be used for more than just paying for near-term, out-of-pocket medical expenses. You are allowed to accumulate money in an HSA for future needs.

Money in an HSA isn’t taxed going in nor when you withdraw it, as long as it is used for qualified medical expenses. In this sense, the tax characteristics of an HSA are superior even to those of an IRA or a 401(k).

Given that medical expenses are a major portion of retirement spending, this means that an HSA can be an important supplement to your retirement savings.

5. Don’t put off long-term healthcare decisions

Major healthcare decisions tend to come up later in life, so it’s all too easy to put them off. Failure to plan ahead can be a big mistake.

When you finally get to the point of needing continual care, you may not be in a state of mind to make the best decisions about how to get that care. It may also be too late to provide for funding that care.

Setting up a healthcare proxy, making plans for long-term care and saving to afford that care should all be part of your overall retirement plan. Like all retirement planning, the sooner you start to address these issues the better.

Whether you live in one of the best or worst states for healthcare, paying medical expenses can be a challenge. These tips could help you meet that challenge.

Richard Barrington, a Senior Financial Analyst at MoneyRates, brings over three decades of financial services expertise to the table. His insightful analyses and commentary have made him a sought-after voice in media, with appearances on Fox Business News, NPR, and quotes in major publications like The Wall Street Journal and The New York Times. His proficiency is further solidified by the prestigious Chartered Financial Analyst (CFA) designation, highlighting Richard’s depth of knowledge and commitment to financial excellence.
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