Assisted living costs a median $145,155 a year in Hawaii, the highest of any state, according to CareScout’s state tables from its 2025 Cost of Care Survey. That is $12,096 a month, or $398 a day, and it is nearly double the national median of $74,400 a year.

CareScout, a Genworth company, ranks the states by price. Hawaii is first. Mississippi is last at $52,425 a year, or $4,369 a month, so a month of assisted living in Hawaii costs more than two and a half Mississippi months.

Hawaii at the top of the assisted living list

The gap between the two ends is $92,730 a year. Hawaii also sits $70,755 above the national figure, which CareScout’s March 2 release put at $6,200 a month. The national median rose 5% over the year before, a faster climb than CareScout reported for nursing home rooms, which rose 2%.

CareScout collected the rates from July to November 2025 across the country. It says the numbers reflect median costs based on provider-reported pricing, and that actual expenses vary with individual care needs, provider availability and local market conditions.

The survey collected more than 25,000 rates from long-term care providers nationwide, gathered at the metropolitan-area level, the release says. Samir Shah, CareScout’s chief executive, is quoted in it describing the survey as a way to bring clarity to families facing a care decision. A state figure is therefore a statewide median, and a single community can price well above or below it.

For a family weighing a move for a parent or a spouse, the practical question is what assisted living would cost in their own state, and what pays for it. Find the state in the table, multiply the monthly figure by twelve, and compare the total with income from Social Security, a pension and savings.

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How other states rank

Alaska is second at $118,578 a year, or $9,882 a month. Massachusetts is third at $115,200, or $9,600 a month. Connecticut is fourth at $109,410, or $9,118 a month.

Oregon ranks 16th at $82,494. Texas ranks 34th at $67,992, which is below the national median. Missouri is 39th at $64,800, and Louisiana is 45th at $61,950, or $5,162 a month.

Over five years, Hawaii’s figure adds up to $725,775 and Mississippi’s to $262,125. Prices rise most years, so a family planning that far ahead should expect the totals to run higher.

In Hawaii, assisted living sits close to the price of a nursing home. The same CareScout tables list a Hawaii semi-private nursing home room at $185,679 a year, only $40,524 above assisted living. In Alaska the spread is far wider, with a semi-private nursing home room at $333,975 against $118,578 for assisted living. In Mississippi, a semi-private nursing home room at $114,975 costs more than twice the $52,425 assisted living figure.

The national release adds one more comparison. An in-home non-medical caregiver costs a median $35 an hour, or $80,080 a year at 44 hours of care a week, up 3%. That is above the $74,400 national assisted living median, which is why families sometimes weigh a community against home care once a parent needs help most of the day.

None of these numbers include extras. CareScout reports base rates, and the release says actual expenses depend on individual care needs. A family comparing a quote from a Hawaii community with the state median should ask what the monthly price covers and what costs more.

Medicare and assisted living

Medicare is the first place many families look, and its own page sets the limits. Medicare.gov’s nursing home coverage page says help with daily activities such as bathing, dressing or eating is generally not covered, and that Medicare does not cover custodial care when that is the only care needed. The page does not name assisted living, but those daily tasks are the core of what residents get help with.

Medicare Part A may cover up to 100 days of short-term skilled nursing or rehab care in a Medicare-certified facility after a hospital stay. That is a separate benefit from a monthly assisted living rent, and it ends when the skilled need ends.

What the five-year look-back means

People who expect to rely on Medicaid for long-term care face a rule about gifts. The Centers for Medicare & Medicaid Services says the Deficit Reduction Act lengthened the look-back period to 60 months before the date a person applies, and states review asset transfers made in that window.

For transfers on or after Feb. 8, 2006, a penalty period starts on the later of the transfer date or the date the person enters care and is otherwise eligible. The agency’s backgrounder also describes a home equity cut-off of $500,000, which states can raise to $750,000. Each state runs its own Medicaid program, so whether and how it pays for assisted living is a question for the state Medicaid office.

A family that moves money to relatives to get ahead of a Hawaii-sized bill can trigger the penalty it hoped to avoid. The look-back is the reason to learn the rule before any transfer, not after.

Planning for assisted living at Hawaii prices or Mississippi prices?

At $12,096 a month, a few years of assisted living in Hawaii can use up a retirement nest egg, and a gift made inside the five-year window can delay Medicaid help later. Families often find out how those rules work once a parent has already moved in.

Protect Your Savings From Care Costs is a 10-page guide that sets out what Medicare pays for nursing care, and what it won’t, along with Medicaid’s look-back and how a spouse at home is protected, using 2026 numbers. It ends with a worksheet for a care plan and comes in a large-print edition.

Get the 10-page assisted living cost guide and care-plan worksheet →

This article was produced with AI assistance and edited for accuracy against the sources linked above.