Older adults in the U.S. who are particularly preoccupied with the cost and quality of care, as well as its overall accessibility, may fare worse in the following 10 states.
1. Alaska
Score: 0/100
Alaska’s low ranking can largely be attributed to its limited accessibility to Medicare, as the state doesn’t maintain access to Medicare Advantage plans. Meanwhile, it experienced the second highest average annual growth in Medicare personal expenditures from 2021 to 2022.
Alaska ranks:
- Last in terms of the number of hospitals per square mile.
- Worst of all states for the cost of nursing home facility care.
- Worst of all states in terms of its cost of having a heart attack.
- Worst of all states in terms of its cost of audiologist care.
- Second lowest for its number of Medicare Part D prescribers.
2. Wyoming
Score: 3.17/100
Wyoming ranks poorly for older adult health care due to limited Medicare accessibility. For instance, the state has the lowest number of Medicare-participating physicians and practitioners per 100,000 older adults, and it offers the second lowest number of Medicare Advantage plans to its residents.
Wyoming ranks:
- Second lowest in terms of the number of health insurance plans that offer Medicare Advantage to beneficiaries who receive low-income subsidies (also called Extra Help) and/or chronically ill beneficiaries additional options.
- Worst of all states for its number of Medicare Part D prescribers.
- Third highest in terms of its number of unplanned hospital readmissions.
3. West Virginia
Score: 7.11/100
West Virginia struggles with population health, which negatively affects its overall ranking for older adult health care. The state has the highest diabetes mortality rate, as well as the highest percentage of adults who report having obesity. It also has the second highest mortality rate for both respiratory diseases and cancer.
West Virginia ranks:
- Third for quality of care in Medicare-certified hospices.
- Second lowest in terms of the amount residents spend on health care.
- Fourth lowest in terms of the number of dentists per 100,000 older adults.
4. Nevada
Score: 10.17/100
While Nevada residents enjoy the lowest average Medicare Advantage monthly premiums, they also experienced the highest average annual growth in Medicare personal expenditures from 2021 to 2022, negatively affecting its ranking in terms of older adult health care.
Nevada ranks:
- Worst of all states for its number of unplanned hospital readmissions.
- Second highest in terms of the number of people who choose not to see a doctor due to costs.
- Fourth lowest in terms of the number of mental health counselors per 100,000 people.
5. Delaware
Score: 19.73/100
Delaware doesn’t have one standout category that negatively impacts its ranking but rather a few hits across health care costs, quality and accessibility. For instance, the state has the lowest number of dentists per 100,000 older adults. It also has the fourth highest costs of assisted living facility care.
Delaware ranks:
- Fourth worst in terms of timeliness of care.
- Seventh highest for its cancer mortality rate.
- Sixth highest for its costs for cancer treatment.
- Sixth lowest for its number of Medicare Part D prescribers.
6. Maryland
Score: 20.95/100
While Maryland ranks sixth lowest for the average cost of Medicare Advantage monthly premiums, it ranks seventh highest for the average monthly out-of-pocket maximum for Medicare Advantage plans in the state.
Maryland ranks:
- Seventh lowest for its number of Medicare Part D prescribers.
- Fourth lowest for quality of care in Medicare-certified home health services.
- Ninth highest for its costs of assisted living facility care.
- Third highest for the costs of preventative care.
- Third highest for the cost of geriatric psychiatry care.
7. New Mexico
Score: 26/100
New Mexico ranks seventh lowest for health care for older adults largely due to limited accessibility to care. It also has the eighth highest mortality rate for diabetes.
New Mexico ranks:
- Seventh lowest in terms of the number of hospitals per square mile.
- Third lowest in terms of the number of mental health counselors per 100,000 older adults.
- Ninth lowest in terms of the number of dentists per 100,000 older adults.
8. Montana
Score: 26.27/100
Montana faces challenges with health care costs, quality and accessibility. It has the fifth lowest number of Medicare Advantage plan options for older adults, the third highest average annual deductible cost for health insurance coverage and the fourth worst quality of care in Medicare-certified hospital outpatient departments and ambulatory surgical centers services.
Montana ranks:
- Second lowest in terms of the number of hospitals per square mile.
- Seventh highest for its depression mortality rate.
- Seventh lowest in terms of the number of health insurance plans that offer additional options to
- Medicare Advantage beneficiaries receiving low-income subsidies and/or chronically ill beneficiaries.
9. Oregon
Score: 27.47/100
Similar to Montana, Oregon struggles with health care costs, quality and accessibility related to older adult health care. Notably, it ranks seventh highest for its mortality rate from falls. It also ranks third highest for its average cost of nursing home facility care.
Oregon ranks:
- Seventh highest for its average Medicare Advantage monthly premium cost.
- Second lowest in terms of the number of hospital beds per 100,000 older adults.
- Seventh lowest in terms of the number of mental health counselors per 100,000 people.
10. Rhode Island
Score: 28.52/100
Rounding out the bottom 10, Rhode Island is an expensive state for health care for older adults. It has the eighth highest average monthly out-of-pocket maximum for Medicare Advantage plans, the fifth highest average annual premium for health insurance coverage, the sixth highest cost of audiologist care and the fifth highest cost of heart attack treatment.
Rhode Island ranks:
- Seventh lowest for its number of Medicare Advantage plan options.
- Third lowest for the quality of care in Medicare-certified inpatient rehabilitation facilities.
- Second worst in terms of timeliness of care.
- Best of all states for the quality of care in Medicare-certified hospital outpatient departments and ambulatory surgical centers services.