According to a 2025 Commonwealth Fund report, Louisiana, Mississippi, and Kentucky are the worst states for Medicare, largely due to poor access to care, high costs, and low quality, often compounded by limited, strained healthcare infrastructure. Other low-ranking states include Arkansas, Oklahoma, and Alabama, which frequently appear at the bottom for quality and affordability.
Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
Rated best to worst, Vermont, Utah,Minnesota, Rhode Island and Colorado are the top-ranked states across the Commonwealth Fund's Medicare performance indicators for 2025. At the bottom end, Arkansas, , Oklahoma, Kentucky, Mississippi and Louisiana have the lowest scores, ranking 46th through 51st among the states.
The new rankings show that cost problems are not distributed evenly across the country. Bottom-ranked states such as Mississippi, Texas, Montana, New Mexico, Nevada and Alaska report some of the highest levels of cost-driven care avoidance. Mississippi stands out as a clear outlier.
Scorecard Takeaways
Here are some of the biggest Medicare mistakes to avoid:
There isn't one single state with the absolute highest rates across every metric, but Vermont, Alaska, New Jersey, Massachusetts, and New York consistently rank among the most expensive for health insurance premiums, with Vermont often topping charts for individual silver plans, while Alaska leads in overall costs for employer plans, and Northeastern states like NJ/MA/NY have high costs due to high spending and mandates. Factors like provider shortages (Alaska) and state regulations (Northeast) influence these high costs.
There isn't one single "worst" state, as it depends on the metric, but Mississippi, Louisiana, Kentucky, West Virginia, Texas, and South Dakota frequently rank low for access, quality, and affordability, facing challenges like lack of providers, transportation, and lower reimbursement rates, especially in the Southeast. States with low Medicaid expansion enrollment and higher potential impacts from federal cuts, like South Dakota, Wyoming, and Utah, also appear on "worst" lists.
The saddest states in the U.S., often indicated by high rates of depression, poor well-being, and economic struggles, consistently include West Virginia, Kentucky, Louisiana, Arkansas, and Alabama, with other states like Oklahoma, Tennessee, Mississippi, and Oregon also appearing in top rankings. These states often face challenges such as poverty, limited access to mental healthcare, unemployment, and high rates of chronic diseases, contributing to lower overall happiness and higher reported depression levels.
10 Best US States to Live In, According to a New Study
The "roughest" or most dangerous states in the U.S. consistently include Louisiana, New Mexico, Mississippi, Arkansas, Tennessee, South Carolina, Missouri, Alaska, and Texas, based on high violent crime rates (homicides, assaults), property crime, and sometimes poor road safety or economic factors. Louisiana often leads in homicide rates, while New Mexico and Alaska have high violent crime rates per capita, with other Southern and Southwestern states frequently appearing in top rankings for overall danger.
Clever Offers survey shows Nashville and Tampa top the list of best cities to live, as D.C. remains the least desirable with 28% calling it the worst. Key Details: Clever Offers survey finds 69% of Americans like where they live, down from 73% in 2024, while 73% say they could be convinced to move to another state.
Travel outside the U.S.
Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state, and the closest hospital that can treat you is in Canada.