Richard Chance

The best and worst places to die

Every state has a different approach to end-of-life care, funerals, and estate law. We found the best and worst places to die in the U.S.

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Elissa Suh

Elissa Suh

Senior Editor & Disability Insurance Expert

Elissa Suh is a disability insurance expert and a former senior editor at Policygenius, where she also covered wills, trusts, and advance planning. Her work has appeared in MarketWatch, CNBC, PBS, Inverse, The Philadelphia Inquirer, and more.

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Logan Sachon

Logan Sachon

Senior Managing Editor, Life Insurance & Research

Logan Sachon is the senior managing editor of life insurance and research at Policygenius, where she edits life insurance content and leads life insurance surveys and data studies. As a journalist, her work has appeared in The Guardian, Business Insider, CNN Money, BuzzFeed, Money Under 30, VICE, New York Magazine, and elsewhere.

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Many people think about where they want to live and retire, or which states have the best schools and the lowest taxes. Not as many people think about where they want to die. But where you live can have major implications on your quality of life when you’re near death, as well as your family’s financial well-being after you pass away. Being able to easily settle an estate, for example, can benefit everyone during a difficult time. 

“Dying can be made more difficult by stress, disorientation, isolation, pain, not understanding one's circumstances, and other factors,” says writer and journalist Anne Neumann, author of The Good Death: An Exploration of Dying in America. Most people want to die surrounded by the people they love, free of pain, and having lived a fulfilling life, but just as important is avoiding the factors and situations that can work against that.

Keeping this in mind, we looked at all 50 states plus the District of Columbia and measured the data to find and rank the best places to die in 2022.

How we ranked the states

We took a broad view of the end-of-life experience to identify the things that make for a good death. Our index incorporates seven key factors:

  • Funeral costs: The median cost of a funeral, including viewing and burial, was $7,640 in 2020 (the average is $8,112), but costs can range from $6,000 all the way up to $15,000. 

  • Funeral services: The ratio of funeral homes, cemeteries, crematoriums, and related services to 100,000 residents in a given state. A higher number means more options (and price points) to choose from. The average is 48. 

  • Green burial: The percentage of cemeteries that allow for green burials, which are becoming more important as people look to reduce their carbon footprint. The average is 2.4%.

  • Palliative care: The percentage of hospitals that offer palliative care services, which focus on pain relief and other symptom management, along with emotional support for people with a serious illness. It’s been shown to improve quality of life, reduce final medical costs, [1] and — in some cases — even improve survival rates. [2] Hospice care is a form of palliative care. The average is 73%.

  • Medicare providers: The ratio of Medicare providers to 100,000 residents over age 75. A higher number is better — you want to know that you can easily find a doctor and get care when you need it. The average is 7,418.

  • Deaths at home: The percentage of people who die at home as opposed to a medical facility, emergency room, nursing home, or long-term care center. Studies show 70% of Americans would prefer to die at home. [3] Dying at home usually results in lower end-of-life costs than dying in a hospital, too. The average is 34%.

  • Probate shortcuts: These make your estate easier to settle after you die. Most states have simplified procedures in place for your survivors, as long as your estate is worth less than a certain dollar value. A higher value is better: It means more estates can avoid a formal probate process. The average is $62,000.

(For more on these metrics and how we calculated them, including our data sources, see Methodology below.)

The best places to die

1. Vermont

Funeral cost: $8,984 Funeral homes: 73 Green burial: 10.3% Medicare providers: 8,713 Palliative care: 94% Deaths at home: 38.0% Probate shortcut limit: $45,000

In 2022, Vermont is the best state to die in. It ranked fifth for the density of funeral homes and related services, including cemeteries and crematoriums, and third for green burial options. However, the average funeral costs are more expensive than 86% of the country, which makes sense given Vermont’s higher than average cost of living. [4]  

When it comes to the prevalence of palliative care, Vermont ranks number one (in a four-way tie with Rhode Island, New Hampshire, and Delaware). Vermont’s Bill of Rights for Hospital Patients was amended in 2009 to include provisions aimed at raising awareness for palliative services to help patients to demand high-quality care. 

2. Utah

Funeral cost: $7,536 Funeral homes: 24 Green burial: 4.35% Palliative care: 92.9% Medicare providers: 8,166 Deaths at home: 44.2% Probate shortcut limit: $100,000

Utah ranks first in the country when it comes to the number of people who die at home. Why that’s a good thing: “Most of us wish to remain at home [at the end of our lives] and to avoid a medicalized, unfamiliar setting,” Neumann says. “It’s where we most feel to be ourselves, surrounded by family.”

Utah didn’t score well on all metrics, though. The number of funeral homes per person was on the lower side; Utah ranked in the bottom, landing in 45th place.

3. Idaho

Funeral costs: $7,288 Funeral homes: 31 Green burial: 3.9% Palliative care: 66.7% Medicare providers: 7,108 Deaths at home: 42.0% Probate shortcut: $100,000

Idaho came in lower than most states when it comes to health care metrics like palliative care offerings and Medicare providers, ranking 27nd and 33rd, respectively. However, the state pulls its weight for deaths at home, taking the fifth spot for this data point, which helped land Idaho near the top of our list.

4. Ohio

Funeral costs: $7,195 Funeral homes: 66 Green burial: 0.95% Palliative care: 84.8% Medicare providers: 7,607  Deaths at home: 29.4% Probate shortcut: $100,000

Ohio has more affordable funeral costs than 70% of the country (and the lowest funeral costs of our best places to die). Compared to the rest of the country, not as many people die at home in Ohio, though; the state lands in the bottom (42nd) for at-home deaths. About 11,700 people a year spend their last days in a hospital. 

Ohio scored well in palliative care (coming in 6th) and has its own advisory council dedicated to palliative care. [5] The council consults with and advises the Department of Health to establish and implement best practices surrounding palliative care.

5. South Dakota 

Funeral costs: $7,748  Funeral homes: 71 Green burial: 3.5% Palliative care: 88.9% Medicare providers: 8,973 Deaths at home: 21.6% Probate shortcut: $50,000

When it comes to deaths at home, South Dakota ranks second to last. In fact, most people in South Dakota die in a nursing home, which is uncommon in the United States, where hospital deaths are more common than deaths in a nursing home. 

Even so, South Dakota lands in the fifth spot as a result of its other strengths: It scored 6th for the density of Medicare providers, 11th for the availability of palliative care, and 7th for density of funeral homes. 

6. Maine 

Funeral costs: $8,999 Funeral homes: 58 Green burial: 4.0% Palliative care: 76.9% Medicare providers: 8,880 Deaths at home: 37.0% Probate shortcut: $40,000

Maine has higher-than-average funeral costs — the 11th most expensive in the country, in fact — but scored well on other funeral-related metrics. It came in 16th for density of funeral homes and 7th for green burial.

End-of-life metrics are also a mixed bag. The state is middling when it comes to palliative care, and it ranked 15th for deaths at home. However, Maine scored well when it came to general health care. It ranked 7th for the density of Medicare providers. 

7. Colorado (tie)

Funeral costs: $8,132 Funeral homes: 22 Green burial: 3.9% Palliative care: 80.6%  Medicare: 9,573 Deaths at home: 36.0% Probate shortcut: $74,000

Colorado has the fourth-highest density of Medicare providers per capita. On the other hand, it also has the lowest ratio of funeral homes to residents (ranking 45th for this particular metric).

7. Illinois (tie)

Funeral costs: $7,419 Funeral homes: 56 Green burial: 0.6% Palliative care: 81.6%   Medicare providers: 8,854 Deaths at home: 32.7%  Probate shortcut: $100,000

Illinois didn’t score poorly on any metrics. It scored above average for funeral costs (22nd), density of funeral homes (18th), and availability of palliative care (19th), and particularly well for Medicare providers, landing in 8th place. 

9. New Hampshire

Funeral costs: $8,380 Funeral homes: 43 Green burial: 16.7% Palliative care: 100% Medicare: 8,556 Deaths at home: 29.9% Probate shortcut: $0

If environmental causes are important to you, New Hampshire might be the place to settle. It came in first for green burials, making up for the fact that the density of funeral homes and cemeteries is slightly lower than average (it ranked 36), and the funeral costs are higher than the median.

Unlike most states, New Hampshire offers a probate shortcut that isn’t based on the size of the estate. Settling an estate isn’t constrained by how much you own when you die. However, certain other requirements must be met: Your only beneficiary or heir must be either a surviving spouse, a child, or a parent. Therefore, it could be difficult to avoid probate if you named multiple beneficiaries in your will. 

10. Washington 

Funeral costs: $8,620 Funeral homes: 23 Green burial: 2.4% Medicare providers: 9,573 Palliative care: 84% Deaths at home: 40.2% Probate shortcut: $100,000

Funeral costs are expensive in Washington (the 14th most expensive in the country), and funeral homes are hard to come by (it ranked 44th for density), but the state was buoyed by other metrics. It ranked 16th for palliative care and 6th for deaths at home.

The worst places to die

46. New Jersey 

Funeral costs: $9,154 Funeral homes: 50 Green burial: 0.6% Palliative care: 91.8% Medicare: 7,098 Deaths at home: 29.9% Probate shortcut: $50,000

New Jersey landed in the bottom of this list because of its expensive funeral costs and lack of green burials (it ranked 42nd and 40th, respectively). It also scored poorly on deaths at home, coming in 40th. 

On the bright side, New Jersey excels in palliative care, ranking 9th for this data point. In 2019, the state enacted a palliative care law, aimed at identifying patients who could benefit from these services and making information more readily available to them. 

47. New York

Funeral costs: $10,355 Funeral homes: 52 Green burial: 1.1% Palliative care: 80.8% Medicare providers: 7,131 Deaths at home: 29.7% Probate shortcut: $50,000

If you can make it here, you may not want to die here. New York lands among the worst places to die because of the state’s expensive funeral costs and the low percentage of people who pass away at home. Funerals cost more here than in 94% of the country, and New York ranks 41st for deaths at home.

48. Hawaii

Funeral costs: $15,203 Funeral services: 18 Green burial: 3.70%  Palliative care: 66.7% Medicare providers: 5,079 Deaths at home: 37.39%  Probate shortcut: $100,000

Hawaii has the most expensive funeral costs in the country, which makes sense given the high cost of living here. It also has the lowest density of funeral homes and cemeteries — somewhat expected given the limited size of the state. Finding health care could also be a problem in Hawaii, which came in second-to-last for the density of Medicare providers.

Although it landed in the bottom of this list overall, Hawaii scored well for deaths at home, coming in 14th. 

49. Texas

Funeral costs: $7,148 Funeral homes: 31 Green burial: 0.6% Palliative care: 52.2% Medicare providers: 6,173 Deaths at home: 33.0% Probate shortcut: $75,000

Funeral costs here are lower than the nationwide average, but beyond that, Texas doesn’t offer much. The state scored low on all other metrics, ranking 44th for palliative care, 40th for the density of Medicare providers, and 39th for green burial options.

50. Alaska

Funeral costs: $9,913 Funeral homes: 17 Green burial: 0 Palliative care: 42.9% Medicare providers: 14,566 Deaths at home: 43.4% Probate shortcut: $50,000

The low density of funeral homes (49th place), a total lack of green burial cemeteries, as well as expensive funeral costs (45th place) made Alaska the third-worst place to die. 

Even though Alaska ranks in the bottom of the list overall, it did rank second overall for deaths at home. It also scored well on the density of Medicare providers — in fact, Alaska has the highest provider-to-resident ratio in the country. 

51. Florida

Funeral costs: $7,667 Funeral homes: 28 Green burial: 0.84% Palliative care: 64.5% Medicare providers: 4,257 Deaths at home: 29.2% Probate shortcut: $75,000

Florida is the worst place to die in 2022. This may be surprising given its popularity with retirees. One-fifth of Florida residents are over age 65, and 9.5% of Florida residents are over 75 years old; no other state has an over-70 population as big, percentage-wise.  

However, people who retire in the Sunshine State should know Florida ranked 43rd for at-home deaths. It also has the fewest Medicare providers per capita of any state, and it ranks 36th when it comes to the availability of palliative care.

How the rest of the states stack up

Pro tips for end-of-life planning

However your state ranks in end-of-life services, there are several things you and your family can do to smooth the way for a peaceful death. Some of these preparations can even end up being more important than our ranking factors. 

Set aside money for funeral expenses

Rather than prepaying for a funeral in its entirety, it’s better to plan ahead and save, since a funeral home may go out of business. If you don’t have a lump sum set aside, life insurance can help cover funeral expenses. The proceeds from a term life insurance policy can be used for expenses beyond funeral costs. But if you’re ineligible for term life insurance, burial insurance might be a good alternative. ​​Burial insurance is a type of life insurance policy specifically meant to cover funeral expenses. It’s easier to get than term life insurance since it doesn’t require a medical exam; however, it also doesn’t provide as large of a death benefit. 

"While permanent life insurance coverage, like burial insurance, isn't always needed or recommended for everyone, you can benefit if you just want a small policy to pay for end-of-life expenses,” says Certified Financial Planner and Advance Planning Team Lead Patrick Hanzel. “We recommend consulting with a licensed representative to discuss all your options and determine if something like this might be right for you.” 

Make an estate plan

Opening a trust and transferring your assets into it can help defray some of the costs of probate and avoid potential estate taxes. Since a trust is a separate legal entity, its assets can pass to your chosen beneficiaries outside of court and decrease the value of your estate. Having an estate plan in place for giving away your valuable belongings can help make the probate process more efficient after you die.

Life insurance is also integral to estate and end-of-life planning. Not only can the death benefit help pay for estate taxes, it can also be accessed during your lifetime by adding certain riders. An accelerated death benefit can pay out proceeds early if you’re terminally ill, while a long-term care rider can draw on your death benefit to help cover the costs of a nursing home, home health care, or other related expenses.

Create an advance directive

You can decide on what kind of medical care you want ahead of time by creating an advance directive. This document, also known as a living will, lets you specify what treatments you’re open to receiving, like CPR or being hooked up to a ventilator for support, and under what circumstances. Making someone your healthcare proxy or granting durable medical power of attorney gives them the legal authority to make decisions on your behalf if you’re incapacitated, and can’t do so yourself. 

Advance directives provide peace of mind for you, but they’re just as helpful to your family, who won’t be in the painful position of having to make decisions about your treatments. “A good death is not one thing, it is what a patient needs or desires, and so can vary from patient to patient,” Neumann says. When you make an advance directive and share it with your loved ones, they won’t have to wonder about your wishes.

Medical aid in dying

Nine states allow medical aid in dying (also known as physician aid in dying, dying with dignity, and physician assisted-suicide). That means a doctor can prescribe medication to a patient — a mentally capable adult with a terminal diagnosis of six months or less —  to bring about a peaceful death in their sleep.

Physician aid in dying is a controversial topic, but according to Neumann, “studies over more than a decade in Oregon show that a majority of those who receive the medication don't use it. They are comforted knowing that they have it and will not have to endure horrible pain and suffering at the end of their life.” 

When we created our list, we did not take medical aid in dying into account. But as it happens, four of the best places to die on our list have laws in place authorizing such aid. Those states are Vermont, Washington, Colorado, and Illinois.

Hawaii and New Jersey, which landed at the bottom of the list, also authorize medical aid for dying a peaceful death.

Methodology

For each of the categories listed below, we turned each data point into a percentile. This helped us normalize the numbers, or adjust the values to a common scale that still accounted for the difference in the range of values. 

Next, we calculated the average of percentiles for all data points for each state, weighting each category equally. This average percentile became the state’s final score. Then, we ranked those final scores to get the best and worst places. 

  • Funeral costs in 2020: All figures come from our guide to funeral costs (courtesy of National Funeral Directors Association [6] ) except for Washington, D.C., whose figure comes from U.S. Funerals Online. [7]

  • Density of funeral providers in 2019: We divided the number of funeral homes, cemeteries, crematoriums, and related services by the number of residents and multiplied by 100,000. Data comes from the Census Bureau. [8]

  • Green burial options: We divided the number of green burial cemeteries by all cemeteries. Data comes from New Hampshire Funeral Resources and Education [9] and Green Burial Council. [10]

  • Deaths at home from 2018 to 2021: We divided the number of deaths at home by the total number of deaths to calculate the percentage of deaths at home. Data comes from the Centers for Disease Control. [11]

  • Density of Medicare providers 2020: We divided the number of Medicare providers by the state’s older population, which we defined as over age 75, and multiplied by 100,000. Medicare data comes from Centers for Medicare and Medicaid Services [12] and population data from the Census. 

  • Availability of palliative care in 2019: The percentage of hospitals with palliative care services comes from the Center to Advance Palliative Care. [13]

  • Probate shortcut 2022: We assessed estate value limits from state code, which are compiled in the Policygenius guide to small estate affidavits

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Image: Richard Chance

References

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Corrections

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Author

Senior Editor & Disability Insurance Expert

Elissa Suh

Senior Editor & Disability Insurance Expert

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Elissa Suh is a disability insurance expert and a former senior editor at Policygenius, where she also covered wills, trusts, and advance planning. Her work has appeared in MarketWatch, CNBC, PBS, Inverse, The Philadelphia Inquirer, and more.

Expert reviewer

Senior Managing Editor, Life Insurance & Research

Logan Sachon

Senior Managing Editor, Life Insurance & Research

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Logan Sachon is the senior managing editor of life insurance and research at Policygenius, where she edits life insurance content and leads life insurance surveys and data studies. As a journalist, her work has appeared in The Guardian, Business Insider, CNN Money, BuzzFeed, Money Under 30, VICE, New York Magazine, and elsewhere.

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