Public Health & Policy
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Medicare
— Report ranks experiences based on cost, quality, and population health
by Shannon Firth, Washington Correspondent, MedPage Today
October 16, 2025 • 3 min read
Vermont, Utah, and Minnesota led the nation in ranking Medicare beneficiaries’ experiences with the program and its benefits, according to a report from the Commonwealth Fund.
The three lowest-ranked states were Louisiana, Mississippi, and Kentucky, said Gretchen Jacobson, PhD, vice president of Medicare at the Commonwealth Fund, and co-authors.
The organization’s first-ever State Scorecard on Medicare Performance rated states on 31 measures across four key domains: access to care, quality of care, costs and affordability, and population health.
“Medicare is a lifeline for millions of Americans, and for the first time this scorecard shows how people’s experiences with the program vary widely depending on where they live,” said Jacobson in a press release. “In some states, beneficiaries can see doctors quickly and afford their prescriptions; in others, they face higher costs, delays, or red tape. By learning from states where Medicare works best, policymakers and health leaders can strengthen the program for everyone.”
During a webinar on Wednesday, David Radley, PhD, MPH, a senior scientist for the organization, explained that “when we look at the top-performing states, including Vermont, Colorado, Utah, and Minnesota, one of the things that they have in common is that … they do really well on the population health metrics.”
“These are states where they have better … life expectancy at age 65, fewer people reporting poor mental health days, and people giving themselves high self-reported health,” he noted.
Radley pointed out that Minnesota and Vermont also have very low uninsured rates. “For that younger-adult working-age population, that means that [if] people … are sick, if they do have a chronic illness, they’re much more likely to be having that chronic illness managed and keeping that disease in check as they age into Medicare,” he said.
As for the lower-ranking states, Radley pointed to “deep, deep poverty,” and noted that social determinants of health also create barriers to care.
Despite consistency among core benefits, “there are stark differences among states in beneficiaries’ ability to afford care, access doctors, and avoid unnecessary hospitalizations,” the press release noted. “Although Medicare is a federal program, access to care and health outcomes are shaped by a mix of state and local factors — such as the strength of a state’s health system, the affordability of supplemental coverage, and the structure of private Medicare Advantage and drug plans — all of which vary across the country.”
In addition to highest overall score, the report highlighted other important metrics:
- Avoidable hospitalizations: Rates ranged from 14 per 1,000 Medicare beneficiaries in Idaho to almost 35 per 1,000 in West Virginia, Massachusetts, and Alabama
- Prior authorization requirements: Fewer than 10% of Medicare Advantage plans in South Dakota require prior authorization for specialist or preventive visits versus more than 70% in Washington and Virginia
- Affordable care: The proportion of older adults skipping out on care due to cost was fourfold higher in Louisiana compared with Vermont (6% vs 1.6%)
- Prescription drug spending: Beneficiaries in New York paid roughly 4.5% in out-of-pocket costs compared with 13% in North Dakota
- Loneliness: More than a quarter of older adults on Medicare in the 39 states and the District of Columbia where data were available reported feeling lonely or said they lacked emotional support
Jacobson and team pointed out that preventable hospitalizations typically reflect inadequate disease management. “These are hospitalizations for exacerbations of health conditions that could have been avoided with better identification and management in the outpatient setting,” said co-author Kristen Kolb, MPH, RN, a research associate for the Commonwealth Fund.
Another quality metric — the prescription of medications inappropriate for the elderly — was most prevalent in southeastern states, including Louisiana, Florida, Alabama, Arkansas, and West Virginia. “Medications that are potentially inappropriate for the elderly increase the risk of confusion, falls, bleeding risk, and other potential harms,” the authors explained.
Overall, Medicare offers “more stable access to care” than other types of health insurance, and beneficiaries are far less likely to face cost and access barriers compared with younger adults with Medicaid, private coverage, or no insurance, Jacobson and colleagues concluded, with only 3.8% of older adults reporting that they skipped needed care due to cost versus 15% of younger adults.
The report was based on the most recent publicly available data, mainly from 2023 to 2025, including from CMS, certain federal surveys, and vital statistics sources. Individual state profiles also included additional data about the Medicare population by state.
