Based on 2025 data from the Commonwealth Fund, Louisiana, Mississippi, and Kentucky are ranked as having the worst Medicare performance, driven by low access to care, poor quality, and high costs. These, along with other Southern states like Arkansas and West Virginia, often face barriers such as limited infrastructure and higher rates of unnecessary medications.
Overall, the Commonwealth Fund found that Vermont, Utah, and Minnesota were the top three ranked states for Medicare beneficiaries, while Louisiana, Mississippi, and Kentucky were the bottom three.
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.
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.
Vermont, Utah, and Minnesota were the top-ranked states across our Medicare performance indicators for 2025. For Medicare beneficiaries, access to needed care varies greatly depending on where they live.
The table shows how much people pay monthly for Medicare Part D prescription drug plans in different states. The states with the cheapest plans are Mississippi, Kansas, Kentucky, Indiana, Illinois, and Oklahoma, where people pay around $43 monthly.
The lowest-ranked states are Mississippi, Texas, Oklahoma, Arkansas, and West Virginia. Uninsured rates fell to record lows in all states by 2023, and differences in health coverage and access to care narrowed between states.
In 2021, California reported some 6.49 million Medicare beneficiaries and therefore was the U.S. state with the highest number of beneficiaries. Medicare is a U.S. publicly funded health insurance program that covers those that are aged 65 years and older and those that have certain disabilities.
Below are the ten states that scored the worst.
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.
In comparison, the 10 worst states for healthcare were:
Hawaii ranks as the healthiest state with a final score of 79.4. It has the lowest PM2. 5 Annual Average Concentration and a relatively low obesity rate.
If you are a U.S. citizen age 65 or older, you can get Medicare regardless of your work history — but your costs could vary. If you've paid Medicare taxes for at least 10 years, you can enroll in Medicare Part A.
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.
According to WalletHub, the top 10 best states for doctors were: