When Medicare open enrollment began (Oct. 15), the Commonwealth Fund reported on how seniors in all states and the District of Columbia could evaluate how well the program performs in four areas: access to care (five indicators), quality of care (13 indicators), health care costs at the individual and system level (five indicators) and population health (eight indicators). Medicare open enrollment ends Dec. 7.
For journalists, the report, “State Scorecard on Medicare Performance. How Medicare Is Working for Its Beneficiaries,” is useful for many reasons, particularly these three:
- It can help readers, listeners and viewers understand how Medicare in their state ranks against that of other states.
- It explains that Medicare is a federal program, but state and local factors vary widely nationwide. Those factors include the composition of a state’s health system, the affordability of Medicare supplemental coverage and the strength of private Medicare Advantage (MA) and Medicare prescription drug plans (PDPs).
- When reporting on state and local factors, journalists can show how state officials could expand support for low-income Medicare members, improve state oversight of MA and PDPs and invest in stronger health systems statewide, the researchers noted.
“The report uncovers wide gaps in health care access, cost, and quality, and clearly shows that Medicare, while a vital safety net for millions of Americans, is not working the same for everyone,” said Joseph R. Betancourt, M.D., president of The Commonwealth Fund and a practicing primary care physician. “Yet despite being a national program, this scorecard reveals that where you live often shapes your experience, how easy it is to see a doctor, afford prescriptions or avoid preventable hospital stays,” Betancourt said during a briefing for the media.
Stories to cover now
The new report was released as Medicare celebrates its 60th anniversary. It is the first time the Commonwealth Fund has ranked states based on how residents enrolled in Medicare experience the program and its benefits, the fund noted.
The report also shows the value of Medicare as the nation’s best health insurance program. Consider, for example, these facts from the report:
- Medicare covers 20% of all Americans, including 68 million seniors ages 65 and older and more than 7 million disabled younger Americans.
- Medicare offers more stable access to health care than other forms of health insurance. “Older adults with Medicare are far less likely to face cost or access barriers than younger adults with Medicaid, commercial coverage or no insurance at all,” the researchers noted.
- Under Medicare, 3.8% of older adults reported skipping needed care because of cost, compared with more than 15% of younger adults. Only 4% of older adults lacked a usual source of care, versus 21% of younger adults.
Before Medicare, seniors aged 65 and older and young disabled people were likely to be uninsured and unable to access care, Betancourt noted.
Top 3 states: Vermont, Utah and Minnesota
After assessing care delivered nationwide, the researchers found wide variation among all states. “Vermont, Utah, and Minnesota scored highest overall for Medicare beneficiaries’ access to care, affordability, quality and outcomes, while Louisiana, Mississippi and Kentucky ranked lowest,” the report showed.
Some findings journalists might want to explore further include:
- Medicare beneficiaries in the southeastern states were more likely to be prescribed unsafe medications, compared with consumers in other regions.
- The rate of hospitalization from preventable causes, a measure that generally reflects inadequate disease management, is more than double in the lowest-ranked states compared with that of the top-performing states.
Here’s another strong angle: More spending on health care does not always produce better health outcomes. “In at least some states with relatively high per-beneficiary spending, life expectancy at age 65 was lower than in many states with lower spending,” said report co-author David Radley, Ph.D., a senior scientist tracking health system performance for the Commonwealth Fund.
“Taken together, we find that the top-ranked states have several things in common,” Radley added. “They tend to have Medicare Advantage plans that offer more comprehensive services with fewer barriers to receiving care, they have lower per-person Medicare spending, which ultimately translates into more affordable care, and they tend to also perform well for people in the state who are not covered by the Medicare program.”
Prior authorization and affordability
Wide gaps in prior authorization rules was one factor that contributed to the differences among states. More than half of all MA beneficiaries are enrolled in plans that use prior authorization frequently, the report noted.
South Dakota was an outlier because fewer than 10% of MA plans require prior authorization for visits to specialists or for preventive services, the report showed. But more than 70% of MA plans in Washington state and Virginia require prior approval for visits to specialists and for preventive services, the researchers reported.
Another factor that led to differences among states was affordability. The share of older adults who skipped getting care because of cost was nearly four times higher in Louisiana (6%) than it was in Vermont (1.6%), the researchers found.
Similarly, out-of-pocket spending on prescription drugs varied widely. Beneficiaries in New York paid about 4.5% out of pocket for prescription drugs, but in North Dakota, Medicare members paid nearly 13%, the researchers explained.
An epidemic of loneliness
Another factor that leads to poor health outcomes is loneliness, which is widespread among older adults, the report noted. Not all states had data on this metric. But in 39 states and the District of Columbia, at least one in four older adults on Medicare reported feeling lonely or lacking emotional support, challenges that can lead to poorer health outcomes.
“Research has shown that loneliness is a risk factor for hospital readmissions and is associated with increased health care costs,” noted co-author Kristen Kolb, a research associate who tracks the health system performance and expanding coverage and access programs for the Commonwealth Fund.
“Loneliness or lack of emotional support is a widespread issue, affecting at least one in four older adults in every state where data was available,” she said. “Loneliness can have negative health effects and has been linked with poorer health outcomes like increased risk of heart disease and stroke.”
Policy implications
The report highlights that all states’ policies, health care infrastructure and clinical practice norms affect all state residents, including those on Medicare, said Gretchen Jacobson, Ph.D., vice president of Medicare, Expanding Coverage and Access at the Commonwealth Fund. The combination of state and federal health policy enables beneficiaries to get the health care they need, and ultimately affects their health outcomes and experience with care, she added.
“Policymakers can improve care by setting standards for private plans and participating providers and can also incentivize providers to apply best practices and reduce wasteful spending in care,” Jacobson said.
Resources
- “Big Changes Are Coming for 2026 Medicare Plans. What You Need to Know,” Anna Wilde Mathews, The Wall Street Journal, Oct. 15, 2025.
- Medicare Health Outcomes Survey, Centers for Medicare and Medicaid Services, June 4, 2025.
- “Characteristics of Medicare Advantage (MA) Plans and Quality-of-Life and Health Outcomes of Medicare Beneficiaries: Evidence from Medicare Health Outcomes Survey,” Rashmita Basu, Journal of Aging and Social Policy, October 2025.
- “Original Medicare vs. Medicare Advantage: What’s the Difference?” National Council on Aging, Oct. 14, 2025.
- Comparing Original Medicare and Medicare Advantage, Medicare Rights Center.
- “Medicare, Medicaid and the Older Americans Act turn 60. Will they survive the next 60 years?” AHCJ, July 3, 2025.
