Medical costs can make up a chunk of retirement expenses – but where a retiree chooses to live can have a significant impact on that spending.
Most adults 65 or older will rely on the government’s Medicare program for health insurance when they retire. On average, a retiree would need up to $428,000 saved to cover Medicare premiums, deductibles and prescription drugs in their golden years, according to a 2025 study from nonpartisan benefits and public policy research firm Employee Benefit Research Institute. Yet, the average retiree has just under $290,000 saved for retirement.
Therefore, finding a city that has affordable and high-quality healthcare is as important as ever for those getting ready to exit the world of work.
The Independent analyzed all 50 states based on three categories: overall cost of living, state Medicare performance and average annual medical expenses.
In the three states that came out on top, these cities beat the national average for cost of living and had hospitals recognized for outstanding care.
Steeltown savings
Pittsburgh’s blue-collar reputation belies the city’s rise over the past decade as a hot spot for culture, according to tourism publication VisitPITTSBURGH. Overall, Pennsylvania offers a solid trio of affordable cost of living, top-20 Medicare performance, and top-15 health cost of living:
- Overall cost of living: No. 25
- Medicare performance: No. 16
- Health cost of living: No. 12
Pittsburgh’s overall cost of living is 2 percent below the national average, according to workplace compensation firm Payscale. Travel + Leisure magazine named it the best city in Pennsylvania for retirement in 2024, and U.S. News & World Report named Pittsburgh among the top-10 places to retire the same year.
“Steeltown’s” University of Pittsburgh Medical Center is home to multiple award-winning hospitals. Magee Women’s Hospital earned a top-100 award for joint replacements from healthcare ranking and reviews site Healthgrades.
Pittsburgh’s UPMC Presbyterian has earned Healthgrade awards for outstanding patient experience (in 2023 and 2024) and ranked among the top 100 hospitals in the country for gastrointestinal and stroke care.
Cornhusker care
Omaha, Nebraska, has an excellent cost of living and Medicare performance that balances out an average health cost of living:
- Cost of living: No. 13
- Medicare performance: No. 15
- Health cost of living: No. 24
The city’s cost of living is 10 percent below the national average, according to Payscale. The city earned a spot in the National Education Association’s 2026 list of 23 affordable retirement spots for educators.
Omaha’s Methodist Hospital has a consistent track record of providing excellent outpatient care, earning Healthgrades’ Outstanding Patient Experience Award in 2023, 2024 and 2025, and winning Healthgrades’ Excellence Award in 2025 and 2026 for its outpatient joint replacements and prostate care.
The city’s CHI Health Lakeside was named to Healthgrades’ 2026 lists of the 250 best hospitals in the country and the 100 best hospitals for critical care.
Healthy hawkeyes
Des Moines, Iowa, offers a strong combination of excellent cost of living and a top-20 rating for Medicare performance and health cost of living:
- Overall cost of living: No. 9
- Medicare performance: No. 18
- Health cost of living: No. 17
The city’s cost of living is 16 percent lower than the national average, according to employment data site Payscale.
The city’s MercyOne Des Moines Medical Center was named to hospital rankings site Healthgrades’ list of America’s 250 best hospitals in 2024 and was among Healthgrades’ top 100 hospitals for coronary intervention in 2026. Additionally, the hospital won a Healthgrades Coronary Intervention Excellence Award in 2025.