Medicare State Scorecard Reveals U.S. Disparities in Access and Quality
When Medicare Is National but Local Realities Differ
Medicare coverage touches nearly one in five Americans. It’s a proud achievement that ensures older adults and certain disabled individuals have a baseline of protection. But the experience of Medicare beneficiaries is far from uniform. Depending on where someone lives, factors like access, affordability, and care quality can differ dramatically. A fresh look at the Commonwealth Fund’s State Scorecard on Medicare Performance underscores just how vast those differences remain.
A Tale of Two States: Access vs. Quality
Take Connecticut, for example. About 20 percent of its residents rely on Medicare, placing it 12th nationwide in terms of coverage reach. The state benefits from strong policies encouraging preventive and routine care: nearly all Medicare enrollees receive checkups, and relatively few skip dental visits.
Yet Connecticut’s shine fades when it comes to outcomes and care quality. It ranks 31st nationally in quality of care, weighed down by higher rates of hospital readmissions and avoidable emergency visits. That contrast—very good access, middling to poor follow-through in outcomes—shows how multifaceted “success” in Medicare really is.
On the other end of the spectrum, top-ranked states like Vermont, Utah, and Minnesota manage that balance better. They not only promote access but also keep per-beneficiary Medicare costs lower and offer broader Medicare Advantage and prescription drug plan options. Their health systems tend to be more robust, enabling better care coordination, fewer avoidable hospital days, and outcomes that justify the investment.
Meanwhile, lower-performing states face steeper headwinds: higher costs to beneficiaries, health system bottlenecks, and population health challenges that drag on performance.
What Moves the Needle? Key Drivers Behind State Variations
It isn’t just luck or geography. Several recurring themes help explain why some states fare better than others:
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Health Infrastructure & Coordination: Strong health systems—particularly those that integrate hospitals, primary care, and community services—shine in the rankings.
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Cost Management & Plan Options: States that keep per-beneficiary Medicare spending in check, while offering choices in supplemental and prescription plans, tend to deliver better outcomes.
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Social & Behavioral Factors: Even nonclinical issues carry weight. For instance, loneliness affects about 25 percent of older adults in 39 states, and it’s tied to higher risks of hospitalizations and worse recovery trajectories.
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Policy Choices & Reforms: States that support value-based care, incentivize preventive services, and manage readmissions with care transitions tend to gain ground.
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Health Equity & Social Determinants: The burden of poverty, educational gaps, transportation hurdles, and food insecurity all play a role in the performance metrics.
As one expert put it:
“Although Medicare is a national program, health outcomes, access to needed care, the affordability of care and quality of care all vary widely for the people it covers”
— Dr. Gretchen Jacobson, Commonwealth Fund
Where Insurers Fit In
For insurance professionals and carriers, these disparities offer both challenges and opportunities:
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Network Strategy & Partnerships: In states struggling with care quality or access, insurers can differentiate themselves by partnering with high-performing providers or investing in care management infrastructure.
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Benefit Design: Tailoring supplemental benefits—like transportation, social support services, or telehealth—can help reduce gaps in states where social determinants weigh heavily.
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Risk Adjustment Awareness: Regions with poorer outcomes or higher underlying health burdens may require more nuanced approaches to risk mitigation and underwriting.
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State Policy Engagement: Insurers can play a constructive role in advocating for reforms in Medicaid expansion, value-based payment models, or better integration of behavioral and social care.
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Data & Predictive Analytics: Leveraging data at the local and state levels helps anticipate trouble spots—such as high readmission zones or areas with many beneficiaries at risk of skipping care.
A Quick Snapshot: State Variation at a Glance
| Metric | Best-Performing States | Struggling States | What This Means for Insurers |
|---|---|---|---|
| Medicare per capita spending | Among lowest in top states | Often much higher in lagging states | Choose networks that control cost without sacrificing quality |
| Readmission & avoidable ER rates | Relatively low | Elevated in many states | Employ care coordination, transitional care models |
| Plan choice & supplemental benefits | Broader in top states | More limited | Innovate benefits to offset state gaps |
| Social health burdens (e.g. loneliness, food insecurity) | Less severe | More prevalent | Incorporate social interventions in care models |
Medicare’s promise is universal—but its performance is anything but uniform. State lines dictate access, outcomes, and costs in ways that many beneficiaries experience firsthand but few understand. For the insurance industry, awareness of these disparities is more than academic—it’s a strategic imperative.
By aligning benefit design, provider partnerships, and data-driven insights with state realities, insurers can help close gaps and push toward a version of Medicare that’s as equitable as it is national in scope.