Census ACS 2023 · 51 states
States With Highest Health Insurance Coverage
Health insurance coverage is a key indicator of healthcare access and economic security. Massachusetts leads the nation with near-universal coverage, a legacy of the state's groundbreaking 2006 healthcare reform that preceded the national Affordable Care Act. States that expanded Medicaid under the ACA generally have higher coverage rates than those that did not. The uninsured rate directly affects health outcomes: uninsured Americans are less likely to receive preventive care, more likely to delay treatment, and face higher rates of medical bankruptcy. Coverage rates are influenced by employment patterns (employer-sponsored insurance remains the primary source), income levels (Medicaid eligibility), state policy choices (Medicaid expansion, marketplace regulations), and the presence of immigrant populations (who may face eligibility barriers). The coverage gap between the best- and worst-covered states represents millions of Americans with fundamentally different access to healthcare.
Key Findings
- 1Massachusetts leads with a health insurance rate of 97.4%, followed by District of Columbia (96.6%) and Hawaii (96.3%).
- 2The gap between #1 Massachusetts and #51 Texas (82.6%) is 14.8 percentage points.
- 3The national median across all states is 92.6% (New Jersey at the midpoint).
- 4The top 10 states are: Massachusetts, District of Columbia, Hawaii, Vermont, Rhode Island, Minnesota, Iowa, Michigan, New York, Wisconsin.
Full Ranking: States With Highest Health Insurance Coverage
Source: Census ACS 2023 5-Year Estimates
| # | State | Insured % | Median Income | Poverty Rate |
|---|---|---|---|---|
| 1 | Wyoming | 88.4% | $74,815 | 7.1% |
| 2 | Wisconsin | 94.7% | $75,670 | 6.6% |
| 3 | West Virginia | 93.8% | $57,917 | 11.9% |
| 4 | Washington | 93.6% | $94,952 | 6.4% |
| 5 | Virginia | 92.9% | $90,974 | 6.8% |
| 6 | Vermont | 96.1% | $78,024 | 5.7% |
| 7 | Utah | 91.3% | $91,750 | 5.7% |
| 8 | Texas | 82.6% | $76,292 | 10.5% |
| 9 | Tennessee | 89.9% | $67,097 | 9.9% |
| 10 | South Dakota | 90.7% | $72,421 | 7.4% |
| 11 | South Carolina | 90.0% | $66,818 | 10.1% |
| 12 | Rhode Island | 95.7% | $86,372 | 7.0% |
| 13 | Pennsylvania | 94.4% | $76,081 | 8.1% |
| 14 | Oregon | 93.8% | $80,426 | 7.3% |
| 15 | Oklahoma | 86.6% | $63,603 | 11.1% |
| 16 | Ohio | 93.6% | $69,680 | 9.2% |
| 17 | North Dakota | 93.3% | $75,949 | 6.2% |
| 18 | North Carolina | 89.6% | $69,904 | 9.4% |
| 19 | New York | 94.9% | $84,578 | 9.8% |
| 20 | New Mexico | 90.5% | $62,125 | 13.7% |
| 21 | New Jersey | 92.6% | $101,050 | 7.0% |
| 22 | New Hampshire | 94.5% | $95,628 | 4.4% |
| 23 | Nevada | 88.7% | $75,561 | 9.0% |
| 24 | Nebraska | 92.6% | $74,985 | 6.7% |
| 25 | Montana | 91.6% | $69,922 | 7.1% |
| 26 | Missouri | 90.8% | $68,920 | 8.4% |
| 27 | Mississippi | 88.4% | $54,915 | 14.3% |
| 28 | Minnesota | 95.4% | $87,556 | 5.5% |
| 29 | Michigan | 95.0% | $71,149 | 8.8% |
| 30 | Massachusetts | 97.4% | $101,341 | 6.6% |
| 31 | Maryland | 93.8% | $101,652 | 6.3% |
| 32 | Maine | 93.4% | $71,773 | 6.5% |
| 33 | Louisiana | 91.9% | $60,023 | 14.2% |
| 34 | Kentucky | 94.1% | $62,417 | 11.8% |
| 35 | Kansas | 91.1% | $72,639 | 7.7% |
| 36 | Iowa | 95.1% | $73,147 | 6.9% |
| 37 | Indiana | 92.4% | $70,051 | 8.4% |
| 38 | Illinois | 93.0% | $81,702 | 8.2% |
| 39 | Idaho | 90.7% | $74,636 | 7.0% |
| 40 | Hawaii | 96.3% | $98,317 | 6.9% |
| 41 | Georgia | 87.4% | $74,664 | 9.9% |
| 42 | Florida | 88.1% | $71,711 | 8.9% |
| 43 | District of Columbia | 96.6% | $106,287 | 10.7% |
| 44 | Delaware | 93.8% | $82,855 | 7.3% |
| 45 | Connecticut | 94.7% | $93,760 | 6.8% |
| 46 | Colorado | 92.3% | $92,470 | 5.9% |
| 47 | California | 93.1% | $96,334 | 8.4% |
| 48 | Arkansas | 91.0% | $58,773 | 11.5% |
| 49 | Arizona | 89.4% | $76,872 | 8.9% |
| 50 | Alaska | 88.8% | $89,336 | 6.8% |
| 51 | Alabama | 90.6% | $62,027 | 11.3% |
Methodology
Rankings are based on American Community Survey (ACS) 2023 5-Year estimates from the US Census Bureau. All 50 states and the District of Columbia are included. The ACS surveys approximately 3.5 million households annually and provides detailed demographic, social, economic, and housing data. 5-Year estimates offer the most reliable data for state-level comparisons by averaging responses over a 60-month period. Percentages may not sum to 100% due to rounding.
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Frequently Asked Questions
Massachusetts has the highest health insurance rate at 97.4%, according to Census ACS 2023 data. District of Columbia and Hawaii round out the top three.
Texas has the lowest health insurance rate at 82.6%. Oklahoma is second-lowest at 86.6%.
The median across all 51 states is 92.6%. Note that the national median and the state-level median are calculated differently — the state median represents the midpoint when all states are ranked.
This data comes from the American Community Survey (ACS) 2023 5-Year estimates published by the US Census Bureau. The ACS surveys approximately 3.5 million households annually and provides the most comprehensive demographic data available between decennial censuses.
Rankings are based on the latest available Census ACS data (currently 2023 5-Year estimates). The Census Bureau releases new ACS data annually, typically in September. Our data was last updated on April 12, 2026.
Rankings are based on American Community Survey (ACS) 2023 5-Year estimates from the US Census Bureau. All 50 states and the District of Columbia are included. The ACS surveys approximately 3.5 million households annually and provides detailed demographic, social, economic, and housing data. 5-Year estimates offer the most reliable data for state-level comparisons by averaging responses over a 60-month period. Percentages may not sum to 100% due to rounding.