Best and Worst States Ranked for Healthcare Quality, Cost, and Access on Medicare

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Best and Worst States Ranked for Healthcare Quality, Cost, and Access on Medicare

A new ranking of all 50 U.S. states and Washington, DC, by insurance technology company shows that even though Medicare is a federal health insurance program, people enrolled in the program receive varying access to quality care depending on where in the country they live.

Medicare is the federal government’s public health insurance program for adults ages 65 and older, as well as for other people who qualify for the program, such as those with certain long-term disabilities. In 2020, there were nearly 63 million Medicare beneficiaries — making it one of the largest providers of health insurance in the country, public or private. Unlike Medicaid — a joint federal–state health insurance program for low-income people that is administered by states, with different rules and eligibility requirements — Medicare is administered centrally by an agency in the federal government.

That means, in theory, that healthcare access and quality should be fairly similar for Medicare beneficiaries across the country.

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Uneven healthcare cost, quality, and access

But the new analysis, based on publicly available information, shows substantial gaps in healthcare cost, quality, and access among the 50 states and the District of Columbia. Each jurisdiction received three different scores based on each of these categories — cost, quality, and access — as well as a combined overall score. A higher number in each category meant a better outcome — in other words, states with lower prescription drug prices were given a higher score in the “cost” category.

Scores for the “cost” category were based on prescription drug prices and deductibles under Medicare Part D plans, the cost of Medicare supplemental plan premiums, premiums and out-of-pocket costs for Medicare Advantage plans, the cost of nursing and assisted living facilities, and overall insurance premiums and out-of-pocket spending.

Scores for the “quality” category looked at overall health outcomes in several categories, which is potentially a problematic way to judge healthcare quality — after all, lots of social and lifestyle factors outside the healthcare system influence health outcomes. The outcomes included in this category were overall life expectancy, proportion of adults with type 2 diabetes, and deaths from falls, heart disease, stroke, cancer, and Alzheimer’s disease.

Scores for the “access” category were based on the number of Medicare prescription drug plans, the proportion of doctors who opt out of Medicare, public hospital system quality, and the number of certain professions and facilities per person — all doctors, geriatricians (doctors who specialize in care for older adults), nurse practitioners, home health aides, skilled nursing facilities, and Medicare rural health clinics.

The top five overall scores went to Minnesota, North Dakota, Massachusetts, California, and Nebraska (in that order). The bottom five overall scores (starting with the worst) went to Oklahoma, Georgia, the District of Columbia, Mississippi, and Louisiana.

Some states that did poorly overall did well in individual categories — and the reverse could also be true. In the “cost” category, Utah got the top ranking (its overall ranking was 14), followed by California, South Carolina (overall ranking: 42), Kansas (overall ranking: 20), and Minnesota. The worst jurisdictions for cost were the District of Columbia, Delaware (overall ranking: 41), West Virginia (overall ranking: 46), Connecticut (overall ranking: 10), and Vermont (overall ranking: 19).

In the “quality” category — which actually measured health outcomes — the top scores went to Connecticut, Massachusetts, New Jersey (overall ranking: 13), Hawaii (overall ranking: 6), and New York (overall ranking: 27). The worst scores went to Mississippi, Oklahoma, West Virginia, Alabama (overall ranking: 44), and Tennessee (overall ranking: 43).

In the “access” category, the top scores went to Maine (overall ranking: 12), Vermont, Minnesota, North Dakota, and West Virginia. The worst scores went to Nevada (overall ranking: 37), Georgia, South Carolina, Utah, and North Carolina (overall ranking: 45).

While most seniors probably won’t decide where to live based on healthcare cost and quality under Medicare, it’s worth taking note of what Medicare coverage options are available in your area, and how these options may impact your costs and access to various doctors and facilities. Your state health department, as well as independent resources (including — and even information from plan providers themselves — may have helpful information as you make coverage decisions.

Want to learn more about saving on your diabetes care? Read “How Your Healthcare Team Can Help You Save on Medications,” “Save Money on Medicines,” and “Do’s and Don’t’s for Saving Money With Diabetes” 

Living with type 2 diabetes? Check out our free type 2 e-course!

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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