Medicare Provides Coverage, But Care Depends on Location

Medicare seems to offer more consistent care across states than other insurance programs; however, where beneficiaries live still affects how they access care, their cost of care and the quality of services they receive, according to data released today by the Commonwealth Fund.

Medicare has been a core piece in the U.S. healthcare system for decades, providing coverage to more than 68 million Americans—nearly all adults over 65 and millions of younger people with disabilities, according to The Commonwealth Fund’s 2025 State Medicare Scorecard. Although it is a national program designed to offer consistent benefits and affordable care across the country, new findings from the scorecard show that the experience of Medicare beneficiaries can still vary widely depending on where beneficiaries live.

The scorecard looks at how well Medicare is working in every state and the District of Columbia, using 31 indicators of access, quality, costs and population health. Drawing on data from 2023 to 2025, the report highlights differences in access to doctors, prescription drug costs and hospital quality between states.

While Medicare continues to deliver more consistent care than other forms of insurance, report authors claim, the Scorecard highlights how local health systems, provider practices and state policies continue to shape affordability and quality of care for millions of beneficiaries.

The Commonwealth Fund conducted this study to evaluate how well Medicare serves beneficiaries across all states. By examining access, quality, costs and health outcomes, the report highlights differences in care and spending and helps policymakers and health leaders identify ways to improve Medicare and make it more fair, effective and affordable.

Methods of the study included measures of having a usual source of care, routine checkups, dental care, prior authorization requirements for Medicare Advantage plans and timely receipt of home health services. Quality of care was measured by preventive care, potentially harmful medications, hospital and emergency department use and quality in hospital, postacute and long-term care settings.

Costs and affordability were measured through Medicare spending per person, the share spent on primary care, out-of-pocket prescription costs and rates of going without care due to cost. Population health data included chronic conditions, functional limitations, mental and physical health status, food insecurity, loneliness and life expectancy at age 65.

Data came from publicly available sources, including CMS, federal surveys and statistics datasets. For each indicator, states were assigned standardized z-scores based on the difference from the 51-state average divided by the standard deviation. Scores were averaged across indicators to create dimension scores, which were then combined to calculate an overall score and rank for each state.

The 2025 Scorecard found that Medicare continues to provide relatively consistent access, quality and affordability for older adults across the U.S., but meaningful differences continue depending on where beneficiaries live.

For example, Vermont, Utah and Minnesota rank highest overall, reflecting strong state health systems, low per-person Medicare spending and Medicare Advantage and drug plans that provide generous coverage and reduce barriers such as prior authorization.

These disparities are particularly evident for the more than 10 million Medicare beneficiaries who live in rural areas, including 3.4 million in the most rural counties.

According to a KFF analysis, more than 10 million Medicare beneficiaries live in rural areas, including 3.4 million in the most rural counties, where long travel times, fewer local providers and higher reliance on traditional Medicare can affect access to care. Rural beneficiaries are more likely than those in urban areas to have low incomes, multiple chronic conditions or permanent disabilities, and they often report food insecurity or health care cost-related problems, the analysis noted.

Telehealth use is also lower in rural areas because of limited broadband access, highlighting how geography and infrastructure can shape beneficiaries’ experiences even within a national program.

Access varies widely.

In the scorecard, it was found that fewer than 10% of Medicare Advantage plans in South Dakota require prior authorization for specialist or preventive care compared with more than 70% in Washington. Quality of care is different among states as well, with preventable hospitalizations ranging from 14 per 1,000 beneficiaries in Idaho to nearly 35 per 1,000 in West Virginia.

Costs and out-of-pocket spending show similar disparities, with beneficiaries in New York paying 4.5% of prescription costs versus 12.8% in North Dakota. It was found that Medicare also performs better in states with lower overall health system costs and stronger infrastructure, showing how state-level factors shape beneficiaries’ experiences even within a national program.

Population health also varies.

Roughly two-thirds of traditional Medicare beneficiaries have three or more chronic conditions, loneliness affects at least 25% of older adults and life expectancy at 65 ranges from 20.6 years in Hawaii to 16.1 years in Mississippi and West Virginia.

In addition, around 3.8% of adults 65 and older report skipping care due to cost, with state rates ranging from 1.6% in Vermont to 6.0% in Louisiana. Enrollment in low-income subsidy programs helps reduce these differences, but differences in income and supplemental coverage still affect experiences.

The Commonwealth Fund’s State Medicare Scorecard provides a state-level look at Medicare performance, highlighting geographic differences in care and spending.

The report’s strengths include using recent publicly available data and comparing states across multiple dimensions to show high- and low-performing areas. Limitations include gaps in data for Medicare Advantage enrollees, limited information on beneficiaries under 65 and lack of state-level measures for some affordability and outcome indicators.

The authors suggest improving federal oversight, enhancing low-income programs and investing in state health systems to reduce disparities and support better care for all Medicare beneficiaries.