Wyoming has the most expensive health insurance premiums in America, according to a new study ranking the best and worth states for health care. The study estimates the average cost to insure a family in the Cowboy State is $960 per month, more than twice the price in Massachusetts, which has the lowest average premium nationwide.

The study also cited a shortage of doctors in Wyoming, which trailed only Idaho for the fewest number of physicians per capita. Wyoming also ranked 48th for retention of medical residents, 37th for access to medical facilities, and 36th for medical costs, finishing 27th overall in the health care study. Wyoming did rank among the top 20 states for patient outcomes.

Around the region, Colorado was ranked as the 11th best state for health care, followed by Montana (17th), South Dakota (18th), Utah (19th), Nebraska (22nd), and Idado, which finished just behind Wyoming in 28th place.

Minnesota topped the study, followed by Massachusetts, Rhode Island, the District of Columbia, and Vermont. Alaska ranked last with North Carolina, Mississippi, South Carolina, and Arkansas rounding out the five worst states for health care.