Senior care costs vary enormously by state — a nursing home semi-private room ranges from under $5,000/month in some states to over $14,000 in others. Our Affordability pillar ranks states using a cost-weighted average across all seven care types, comparing each to the national median.
If budget is your primary concern, the states at the top of this list offer significantly lower costs. But affordability alone doesn't tell the whole story — check the other pillar scores to see if lower costs come with tradeoffs in quality, staffing, or access.
Affordability is one of five pillars in our Elder Care Index. See how states rank on quality, staffing, access, Medicaid, or view the overall rankings.
Missouri's median assisted living cost of $3,000/month is 35% below the national median of $4,591 — and its nursing home costs ($6,548/month semi-private) are 41% below average. Every care type in Missouri comes in at least 22% cheaper than the national median. The Southern and Central states dominate the top of this list, with Texas, Oklahoma, Arkansas, and Louisiana all clustered within a few points.
Alaska is a dramatic outlier. Nursing home costs run 183% above the national average, and every single care type costs at least 48% more than the median. The state's remote geography, high cost of living, and difficulty attracting healthcare workers to rural areas make it structurally the most expensive place for senior care in the country — scoring a flat 0 on affordability.
The cheapest states often rank poorly on staffing. Texas is #2 for affordability but #49 for staffing. Oklahoma is #3 for affordability but #44 for staffing. The pattern holds across the South: lower costs come with fewer nurse hours per resident. The exception is North Dakota — affordable (#5), with above-average access and a top-10 overall grade. Check the overall rankings before choosing purely on cost.
| # | State | Grade | Score | Assisted Living | Nursing Home | vs National Avg |
|---|---|---|---|---|---|---|
| 1 | Missouri | A | 100 | $3,000/mo | $6,548/mo | -34% |
| 2 | Texas | C | 96 | $3,998/mo | $5,639/mo | -21% |
| 3 | Oklahoma | B | 94 | $3,855/mo | $6,641/mo | -23% |
| 4 | Arkansas | A | 94 | $3,760/mo | $7,362/mo | -23% |
| 5 | Louisiana | B | 94 | $3,748/mo | $7,707/mo | -23% |
| 6 | Alabama | B | 93 | $3,503/mo | $8,397/mo | -23% |
| 7 | South Dakota | A | 90 | $3,350/mo | $9,086/mo | -21% |
| 8 | Kentucky | A | 89 | $3,448/mo | $8,992/mo | -21% |
| 9 | Georgia | D | 89 | $3,535/mo | $9,086/mo | -19% |
| 10 | South Carolina | D | 88 | $3,612/mo | $9,227/mo | -19% |
| 11 | Mississippi | D | 88 | $3,500/mo | $9,931/mo | -21% |
| 12 | North Dakota | A | 88 | $3,391/mo | $9,148/mo | -18% |
| 13 | Utah | B | 87 | $3,500/mo | $8,616/mo | -17% |
| 14 | Kansas | A | 87 | $4,580/mo | $7,989/mo | -10% |
| 15 | Arizona | B | 86 | $4,000/mo | $7,832/mo | -12% |
| 16 | North Carolina | C | 86 | $4,010/mo | $9,086/mo | -14% |
| 17 | Illinois | C | 85 | $4,488/mo | $8,145/mo | -8% |
| 18 | Nebraska | A | 85 | $4,076/mo | $8,631/mo | -11% |
| 19 | Tennessee | F | 85 | $4,105/mo | $9,399/mo | -12% |
| 20 | Iowa | A | 84 | $4,367/mo | $9,195/mo | -8% |
| 21 | Indiana | B | 84 | $4,283/mo | $8,741/mo | -9% |
| 22 | Montana | B | 83 | $4,450/mo | $9,336/mo | -7% |
| 23 | Idaho | C | 82 | $3,838/mo | $10,370/mo | -11% |
| 24 | Ohio | B | 82 | $4,635/mo | $9,305/mo | -6% |
| 25 | Wyoming | F | 82 | $4,169/mo | $10,213/mo | -8% |
| 26 | New Mexico | C | 80 | $4,498/mo | $10,057/mo | -5% |
| 27 | Florida | F | 80 | $4,000/mo | $10,652/mo | -7% |
| 28 | Virginia | D | 79 | $5,250/mo | $8,929/mo | +1% |
| 29 | Michigan | D | 78 | $4,250/mo | $10,965/mo | -4% |
| 30 | Wisconsin | B | 78 | $4,600/mo | $10,370/mo | -2% |
| 31 | Nevada | C | 78 | $3,750/mo | $11,545/mo | -7% |
| 32 | Colorado | C | 76 | $4,750/mo | $10,339/mo | +3% |
| 33 | West Virginia | D | 75 | $4,160/mo | $12,845/mo | -5% |
| 34 | Pennsylvania | C | 75 | $4,100/mo | $12,187/mo | -3% |
| 35 | Minnesota | A | 70 | $4,508/mo | $12,532/mo | +5% |
| 36 | Maryland | F | 67 | $4,900/mo | $12,876/mo | +10% |
| 37 | New Hampshire | F | 63 | $6,053/mo | $12,845/mo | +21% |
| 38 | California | B | 63 | $5,250/mo | $12,046/mo | +20% |
| 39 | New York | B | 62 | $4,580/mo | $15,164/mo | +14% |
| 40 | Maine | C | 62 | $5,865/mo | $13,315/mo | +21% |
| 41 | Vermont | C | 62 | $5,250/mo | $14,099/mo | +17% |
| 42 | Washington | D | 61 | $6,000/mo | $13,095/mo | +24% |
| 43 | Rhode Island | D | 61 | $6,826/mo | $11,748/mo | +30% |
| 44 | New Jersey | F | 59 | $6,495/mo | $12,751/mo | +29% |
| 45 | Delaware | F | 59 | $5,995/mo | $14,599/mo | +24% |
| 46 | Connecticut | F | 58 | $5,129/mo | $15,508/mo | +21% |
| 47 | Oregon | D | 56 | $5,045/mo | $16,292/mo | +21% |
| 48 | Hawaii | F | 55 | $5,375/mo | $15,540/mo | +27% |
| 49 | District of Columbia | A | 55 | $6,978/mo | $11,952/mo | +37% |
| 50 | Massachusetts | D | 53 | $6,500/mo | $14,881/mo | +34% |
| 51 | Alaska | F | 0 | $6,830/mo | $31,282/mo | +85% |
How we calculate these scores → Our Methodology
Missouri has the lowest median assisted living cost at $3,000/month — 35% below the national median of $4,591. Other affordable states include South Dakota, North Dakota, Kentucky, and Mississippi.
Not necessarily. Some affordable states like North Dakota and Kentucky score well on overall quality. However, states like Texas and Mississippi combine low costs with below-average staffing, so individual facility research is critical.
We calculate a cost-weighted average of each state's percentage difference from the national median across all seven care types (adult day, home aide, independent living, assisted living, memory care, nursing home semi-private, and nursing home private). Higher-cost care types like nursing homes are weighted more heavily.