What state has the most expensive assisted living?

According to a 2025 estimate, Hawaii and Alaska have the highest annual costs for assisted living, at $139,807 and $126,047, respectively. This significant price variation across the country raises the question: What state has the most expensive assisted living? The answer depends on the year and the source, but consistently includes states with a high cost of living.

Quick Summary

The states with the highest assisted living costs are consistently Hawaii and Alaska, along with several states in the Northeast and on the West Coast. Price variations are due to factors like local cost of living, labor costs, demand, and amenities offered by facilities.

Key Points

• Hawaii and Alaska top the list: Based on multiple reports, Hawaii and Alaska have the highest median monthly and annual assisted living costs in the US due to geographic isolation and high living expenses.

• Northeast states are also expensive: Several states in the Northeast, including New Hampshire, Massachusetts, and New Jersey, consistently rank among the most expensive for assisted living.

• Cost of living is the biggest factor: Higher costs of living in a state, affecting everything from property values to labor costs, are the primary driver of higher assisted living prices.

• Urban vs. rural variations: Assisted living is typically more expensive in urban areas compared to rural parts of the same state, reflecting local economic conditions.

• Amenities and care level influence price: The level of luxury, available amenities, and the degree of care a resident needs all significantly impact the final cost.

• Prices are rising: The national median cost for assisted living has been on the rise, increasing by approximately 10% from 2023 to 2024, emphasizing the need for robust financial planning.

• Comparing options requires detail: Because pricing models can vary from all-inclusive to a la carte, thoroughly comparing a facility's total costs, not just the base price, is essential.

Hawaii and Alaska frequently lead national rankings

Several recent reports identify Hawaii and Alaska as having the highest assisted living costs in the United States. For 2025, SeniorLiving.org estimated Hawaii's annual assisted living cost at approximately $139,807 and Alaska's at $126,047. In addition to these two states, Northeast and West Coast states typically have significantly higher assisted living expenses compared to those in the South and Midwest.

• Hawaii: The high cost of goods and services due to its geographical isolation drives up all living expenses, including assisted living. For 2025, one source estimated a monthly cost of $11,650.
• Alaska: Similar to Hawaii, Alaska's remote location and high cost of living contribute to its top-tier assisted living costs, estimated at $7,350 per month in a 2025 report.
• Massachusetts: In the mainland U.S., Massachusetts is consistently ranked as one of the most expensive states for assisted living, with an estimated 2025 annual cost of $111,957.
• New Jersey and New Hampshire: These New England states also appear frequently on lists of the priciest assisted living states due to high regional costs.

Factors driving up assisted living costs

Several factors contribute to the dramatic variation in assisted living costs from one state to another. A high-cost-of-living state will have higher property values and labor costs, which directly impact a facility's operating expenses.

Location and amenities

Urban areas and regions with a higher concentration of luxury senior living communities tend to have higher prices. For example, even within a state like New York, costs can be significantly higher in Manhattan than in rural areas. The amenities offered, such as gourmet dining, resort-style facilities, and private rooms, also add significantly to the monthly price.

Staffing and care level

The ratio of caregivers to residents and the qualifications of the staff directly influence costs. A facility offering specialized services like memory care or on-site nurses requires higher labor costs, which are passed on to residents. State-specific regulations on staffing levels and facility requirements can also impact operational costs.

Market demand

High demand for assisted living in a particular area, especially in states with a large aging population and limited supply of facilities, can drive up prices. States like California, which have many assisted living communities but also high demand, reflect this trend.

Assisted Living Costs by State: A Comparison

State	Estimated Median Monthly Cost	Geographic Region	Primary Factors for Cost	Cost Ranking
Hawaii	$11,650	West/Pacific	High cost of living, geographic isolation	Most expensive
Alaska	$7,350	West/Pacific	High cost of living, logistics	Top 3
Massachusetts	$9,330	Northeast	High cost of living, demand	Top mainland
New Jersey	$7,334	Northeast	High cost of living, urban centers	Top 5
Vermont	$7,795	Northeast	High cost of living, demand	Top 5
New Hampshire	$6,855	Northeast	High cost of living	Top 10
Mississippi	$3,998	South	Low cost of living, lower demand	Least expensive

Note: Costs vary by report and year. These figures represent recent estimates from the cited sources.

Navigating assisted living costs

When exploring options, it is important to look beyond just the state's average. Costs can differ dramatically between metropolitan and rural areas even within the same state. Many states also offer assistance programs, and veterans may be eligible for benefits. Furthermore, seniors can utilize various funding options, including personal savings, long-term care insurance, and potentially Medicaid waivers, depending on eligibility.

When comparing facilities, understanding the pricing structure is essential. Some communities offer an all-inclusive rate, while others use an a la carte or tiered model. A detailed breakdown of what is included in the base fee—such as meals, housekeeping, and utilities—versus what services incur additional costs, will help families make an informed financial decision.

Conclusion

While overall living costs offer a strong indicator, multiple factors influence which state has the most expensive assisted living. Based on recent data, states with high costs of living, like Hawaii, Alaska, and several in the Northeast, lead the rankings for expense. However, families must compare specific facilities and pricing models to find the best balance of quality care and financial feasibility. Ultimately, the cost is tied to location, amenities, and the level of care required, making careful research a critical step for families planning for long-term care.

Frequently Asked Questions

Which states have the most expensive assisted living costs?

Recent reports and surveys consistently identify Hawaii, Alaska, Massachusetts, New Jersey, and New Hampshire as having some of the highest assisted living costs in the nation due to high overall costs of living and demand for senior care.

What is the average monthly cost of assisted living in expensive states?

For 2025, estimates show average monthly costs in the most expensive states can range from about $6,800 to over $11,000, depending on the state and the specific facility.

Do assisted living costs vary within a state?

Yes, costs can vary dramatically even within a single state. Facilities in urban or more affluent areas will almost always cost more than those in rural or less populated regions, reflecting local real estate and labor markets.

What factors make assisted living more expensive in certain states?

Key factors include a state's overall cost of living, real estate values, labor costs for caregivers, demand for senior care services, and state-specific regulations.

Is assisted living more expensive than other types of senior care?

Assisted living is typically more expensive than independent living but less expensive than skilled nursing home care. However, costs can vary widely, and in-home care costs depend entirely on the number of hours of care required.

Does Medicare pay for assisted living in high-cost states?

No, Medicare does not cover the costs of long-term care like assisted living. It may cover some specific health-related services while in the facility, but room and board are not covered.

How can families afford assisted living in high-cost states?

Families can use a variety of strategies, including personal savings, long-term care insurance, veterans' benefits, and state-specific Medicaid waivers. It is recommended to explore all funding options and assistance programs.