Gulf South States Rank Lowest in 2025 Medicare Scorecard for Access and Quality

The Commonwealth Fund's 2025 State Medicare Scorecard reveals significant regional disparities in Medicare performance across the United States, with Gulf South states ranking at the bottom nationally.

Louisiana ranks last overall, followed closely by Mississippi and Alabama. The scorecard assesses states on 31 indicators across access to care, quality of care, costs and affordability, and population health, using recent data from CMS and national health surveys.

Chronic disease burden and social determinants such as loneliness among older adults heavily influence Medicare outcomes in these states. Approximately two-thirds of traditional Medicare enrollees nationwide live with multiple chronic conditions, necessitating effective care coordination and access to services—areas where the Gulf South continues to face challenges due to systemic factors like physician shortages, poverty, and limited eldercare infrastructure.

Economic vulnerability is a key driver of poorer outcomes, as evidenced by higher percentages of beneficiaries eligible for low-income subsidies in Louisiana and Mississippi compared to the national average. Cost-related barriers contribute to delayed or forgone medical care despite Medicare coverage, impacting medication adherence and health management.

State-level policy differences also affect outcomes; for example, Louisiana’s Medicaid expansion may offer some benefit by improving health status prior to Medicare enrollment. However, Louisiana reports the highest rates of financial barriers to care and low quality-of-care indicators, including inappropriate medication use and high nursing home readmission rates.

Mississippi displays extreme economic challenges within its Medicare population, with the lowest median household income for older adults and the highest mortality rates for hospitalized beneficiaries with serious conditions. Alabama, while ranking higher than its neighbors, still exhibits challenges in care quality and affordability but shows relatively strong rates of routine health checkups.

These findings highlight the importance of regional health infrastructure, economic conditions, and policy environments in shaping Medicare beneficiaries’ experiences. Improving outcomes in the Gulf South will require addressing underlying systemic challenges to access, affordability, and care quality within the Medicare program.