The U.S. Cities Where Health Care Costs Hurt the Most (And the Least)

In 2025, healthcare was one of the main drivers of the U.S. economy. So much so, in fact, that the Centers for Medicare and Medicaid Services (CMS) expects health spending to reach $5.6 trillion by the end of the year.

How much of this, we wonder, is coming from everyday Americans? And, furthermore, where in these 50 states is spending the greatest (and the least)? Fortunately, researchers over at WalletHub have figured that out for us. Let’s take a look.

How This Was Calculated

WalletHub looked at 100 of the largest U.S. cities and analyzed the cost of five everyday health care staples: a doctor visit, a dentist visit, an optometrist visit, plus common medications like ibuprofen and insulin glargine. Those costs were added together and then compared to the city’s median household income.

The key detail here is that this ranking isn’t just about high prices. Rather, it’s about how expensive health care feels once income is factored in. A city can have relatively average medical prices and still rank poorly if wages are low.

The 10 Cities Where People Spend the MOST on Health Care

These cities see the largest share of income going toward basic medical needs:

Detroit, Michigan, takes the top (worst?) spot, with residents spending over 13% of their median household income on health care. Interestingly, Detroit isn’t outrageously expensive for every medical service, but incomes are among the lowest in the country, which makes even average costs feel brutal.

Cleveland, Ohio, isn’t far behind, largely for the same reason: it has the lowest median household income of any city in the study. Newark, New Jersey, rounds out the top three, where lower wages combine with higher-than-average prices for certain doctor and dentist visits.

The common theme here is that health care costs hurt most when income can’t keep up.

The 10 Cities Where People Spend the LEAST on Health Care

On the other end of the spectrum, these cities see the smallest income share going toward medical costs:

West coast represent! Gilbert, Arizona, comes in dead last, in a good way, with health care costs taking up just about 3.5% of median household income. Many of these lower-spending cities benefit from higher wages, even if medical prices themselves aren’t cheap.

California dominates this list, which may feel counterintuitive until you remember that income plays a massive role here. In places like San Jose, Irvine, and Fremont, higher household earnings soften the blow of pricey doctor visits and prescriptions.

Affordability is Contextual

If this study proves anything, it’s that affordability is relative to income. What seems inexpensive to someone sitting on six figures is not going to feel as easy for a low-income household.

Where you live can quietly determine whether health care feels like a manageable expense or a monthly financial stressor. And while budgeting and emergency funds can help (in theory), location still plays a bigger role than most of us would like to admit.

So if health care feels expensive where you live… you’re probably not imagining it.

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