Where nursing homes cost the most — and least (2025)

A five-fold gap for the same room

The national median for a semi-private nursing-home room is $11,029 a month, but that single number hides one of the widest geographic spreads in American health care. At the top, Alaska runs $27,831 a month — more than double the national figure and nearly five times the cheapest state. At the bottom, Texas runs $5,627 a month. Two families buying the same clinical service, a shared room with 24-hour nursing, can face bills that differ by more than $22,000 every month depending only on where they live.

Alaska is a genuine outlier. Its cost reflects a tiny, remote facility base, the expense of recruiting clinical staff to the far north, and supply chains that inflate every line item from food to fuel. Strip Alaska out and the high tier becomes a recognizable cluster of high-cost, high-wage states: Oregon at $16,760, New York at $15,528, Hawaii at $15,473, and Connecticut at $15,208. These are places where real estate, unionized labor, and strict staffing regulation all push the per-diem rate up. A family in any of them should plan on roughly 40 to 50 percent above the national median.

The low tier is a real option, not a quality compromise

The least expensive states cluster across the South and lower Midwest. After Texas, the next cheapest are Missouri ($6,741), Oklahoma ($7,026), Arkansas ($7,452), and Louisiana ($7,604). It is tempting to read low cost as a warning sign about quality, but the two do not move together — Arkansas, one of the cheapest states, posts an above-average CMS rating, while several mid-priced states score poorly. We examine that disconnect directly in does paying more buy better care? The lesson for families weighing a relocation or an out-of-state placement is that the low-cost tier can be a legitimate value, not an automatic trade-off.

Why the geography matters more than the room

The practical consequence is that where care happens dwarfs almost every other cost lever a family controls. Choosing a semi-private room over a private one saves about 9 percent; choosing Texas over Connecticut saves nearly 65 percent. For families with the flexibility to place a parent near an out-of-state adult child, the geographic spread can be the difference between a plan that lasts three years and one that lasts ten. It also reframes the role of long-term-care insurance: a fixed daily benefit that comfortably covers a Missouri nursing home may cover barely a third of an Alaskan one. Anyone buying a policy is implicitly betting on which state they will need care in decades from now.

The broad middle, and the variation hidden inside it

Between the Alaskan ceiling and the Texan floor sits the bulk of the country, clustered within a few thousand dollars of the $11,029 national median. Most large states — the kind where the majority of Americans will actually seek care — land in this band, which is reassuring in one sense: a typical family is not facing the extremes. But the state median itself conceals a second layer of variation that matters just as much. Within almost any state, a nursing home in the largest metropolitan area can run a third more than the same service in a rural county two hours away, because urban wages and real estate carry the per-diem rate upward. A family that treats the state median as a fixed price will be surprised in either direction; a family that uses it as the midpoint of a wide local range will plan well. The county-level breakdowns on our state pages exist precisely to expose that intra-state spread, so the search can start from a realistic local number rather than a statewide average that may describe no single facility a family will ever tour.