Best and Worst States for Senior Healthcare in 2027

Best and Worst States for Senior Healthcare in 2027

Where you live shapes how well Medicare works for you. Your Part A and Part B benefits are the same in every state, but your access to doctors, the quality of local care, what you pay and how many Medicare plans you can choose from are not.

The short answer: Vermont, Utah, Minnesota, Rhode Island and Colorado rank as the best states for Medicare beneficiaries, according to the Commonwealth Fund’s State Scorecard on Medicare Performance. Louisiana, Mississippi, Kentucky, Oklahoma and Arkansas rank last. America’s Health Rankings’ 2026 Senior Report, a separate study, puts Vermont, Utah, New Hampshire, Minnesota and Colorado at the top.

Below we break down the rankings by access, quality, costs and health, show how many Medicare Advantage plans the top states offer for 2027 and explain what it all means for your coverage.

Best States for Senior Healthcare: Top 10

The Commonwealth Fund ranked all 50 states and Washington, D.C. on 31 measures of how Medicare is working for the people who use it, grouped into four areas: access to care, quality of care, costs and affordability, and population health. A lower number is better.

Source: Commonwealth Fund, State Scorecard on Medicare Performance (October 2025), Appendix B2.

Vermont ranks first overall and second for both access to care and population health.

Utah is second overall and second for quality of care, making it one of the most balanced states on the list.

Minnesota ranks first in the country for population health and in the top 10 for access and quality.

Rhode Island ranks first for access to care.

Colorado ranks first for quality of care.

No state is strong on everything. Hawaii ranks fourth for quality and costs but 42nd for access, and Massachusetts ranks fourth for access but 32nd for quality.

Worst States for Senior Healthcare

These states rank near the bottom on quality of care and population health. The Commonwealth Fund found that 6.0% of older adults in Louisiana skipped care because of cost, compared with 1.6% in Vermont.

Among the largest retiree states, Florida ranks 40th overall and 47th for quality of care, Texas ranks 46th and California ranks 31st.

Best States by Category

Best states for access to care

1. Rhode Island
2. Vermont
3. Pennsylvania
4. Massachusetts
5. Connecticut

Access measures include routine checkups, having a personal doctor, dental visits and how quickly home health care starts after a referral. New Mexico, Alaska, Montana, California and Texas rank lowest for access.

Best states for quality of care

1. Colorado
2. Utah
3. Washington
4. Hawaii
5. South Dakota

Louisiana, Mississippi, West Virginia, Alabama and Florida rank lowest for quality of care.

Best states for costs and affordability

1. Alaska
2. Washington, D.C.
3. Arizona
4. Hawaii
5. Maine

This category looks at Medicare spending and the cost burden on beneficiaries. North Dakota, Kansas, Oklahoma, South Dakota and Nebraska rank lowest.

Best states for population health

1. Minnesota
2. Vermont
3. North Dakota
4. New Hampshire
5. Nebraska

Arkansas, Louisiana, Kentucky, Mississippi and West Virginia rank lowest.

A Second Opinion: America’s Health Rankings 2026 Senior Report

America’s Health Rankings, from the United Health Foundation, ranks states on 56 measures of older adults’ health, from social and economic factors to clinical care. Its 2026 Senior Report, released May 14, 2026, lists these as the healthiest states for older adults:

1. Vermont
2. Utah
3. New Hampshire
4. Minnesota
5. Colorado
6. Massachusetts
7. Washington
8. Connecticut
9. Maryland
10. Hawaii

West Virginia, Arkansas, Kentucky, Mississippi and Louisiana rank lowest. Seven of the top 10 states also make the Commonwealth Fund’s top 10, so both studies point in the same direction.

2027 Medicare Advantage Choices in the Top-Ranked States

A top ranking doesn’t always mean more plan choices. Several of the best-ranked states have far fewer Medicare Advantage plans, and higher average premiums, than big retiree states like Florida and Texas.

Source: CMS, Medicare Open Enrollment state fact sheets for 2027 (September 28, 2026). Plan counts include special needs plans.

Nationally, the average Medicare Advantage premium drops from $14.37 in 2026 to $12.00 in 2027, and 97% of people with Medicare can choose from 10 or more Medicare Advantage plans, according to CMS. Every state has 8 to 12 stand-alone Part D drug plans for 2027, so drug plan choice varies much less by state than Medicare Advantage choice does.

Massachusetts, Minnesota and Wisconsin also use their own standardized Medigap plans instead of the lettered plans sold in other states.

Long-Term Care Costs by State

Medicare doesn’t pay for long-term custodial care, such as help with bathing, dressing or eating in a nursing home or assisted living. It covers skilled nursing facility care only after a qualifying 3-day hospital stay, and only up to 100 days. In 2026 you pay $0 for days 1 to 20 and $217 a day for days 21 to 100.

That makes the cost of care where you live a big part of planning. National median monthly costs in 2025, from the CareScout Cost of Care Survey:

• In-home caregiver (44 hours a week): $6,673
• Assisted living (private one-bedroom): $6,200
• Nursing home, semi-private room: $9,581
• Nursing home, private room: $10,798
• Adult day health care: $2,058

Costs vary widely. A private nursing home room has a median monthly cost of $7,604 in Missouri and Texas but $18,448 in Oregon. Assisted living ranges from $4,369 a month in Mississippi to $12,096 in Hawaii. See our full guide to the best and worst states for long-term care.

What to Look for When Choosing a State for Retirement

Medicare plan choices

The number of Medicare Advantage plans depends on which insurers choose to sell in each county. For 2027, Florida has 560 plans and Vermont has 5. More plans usually means more benefit options and more price competition, but check the star rating of each plan, not just the count. A carrier that earns 4.5 stars in one state can earn 3 stars in another.

You can check availability and compare plans here at Healthcare.com.

What you’ll pay

Medigap premiums are set by insurers state by state, and Medicare Advantage premiums vary by county. Average Medicare Advantage premiums for 2027 range from $0 in Puerto Rico and $0.56 in Nevada to $69.23 in Wyoming. Every Medicare Advantage plan must cap your in-network costs at no more than $9,850 in 2027.

Access to doctors

Rural areas have fewer doctors, specialists and home health workers in almost every state. If you manage a chronic condition, check whether the specialists you need are nearby and whether they take your plan.

Medigap rules

Some states give you extra rights to switch Medigap plans without health questions. California, for example, has a birthday rule that lets you switch to a plan with the same or fewer benefits within 60 days after your birthday each year. Florida has no such rule. Outside your first six-month Medigap open enrollment period, insurers in most states can turn you down or charge more based on your health.

Long-term care options

Look at local nursing home, assisted living and home care costs, and check nursing home quality on Medicare’s Care Compare tool. In CMS’s October 2026 data, Hawaii had the highest average nursing home star rating (3.7) and Illinois and Missouri the lowest (2.5).

How Moving Affects Your Medicare Coverage

Original Medicare works in every state, so a move doesn’t change your Part A and Part B coverage. Medicare Advantage and Part D plans are tied to your service area. If you move out of your plan’s area, you get a special enrollment period to choose a new plan. If you have a Medigap policy, you can usually keep it after you move (unless it’s a Medicare SELECT policy), though your premium may change.

Ways to Lower Your Healthcare Costs in Any State

• Compare plans every fall. Open enrollment runs October 15 to December 7, 2026, for coverage that starts January 1, 2027. Plans change their premiums, drug lists and networks every year.
• Look at total yearly cost, not just the premium. Add up premiums, deductibles, copays and drug costs.
• Check for help paying costs. In 2026, Extra Help is available to people with income up to $23,940 a year ($32,460 for couples) and limited resources, and Medicare Savings Programs can pay your Part B premium if you qualify.
• Know the 2027 drug changes. The Part D out-of-pocket cap rises to $2,400 in 2027, and negotiated prices for 15 more drugs, including Ozempic, take effect January 1, 2027.
• Get free help. Your State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling at shiphelp.org or 877-839-2675.

Frequently Asked Questions

What is the best state for senior healthcare in 2027?

Vermont ranks first in the Commonwealth Fund’s State Scorecard on Medicare Performance and first in America’s Health Rankings’ 2026 Senior Report. Utah, Minnesota, New Hampshire and Colorado also rank in the top five or six in both studies.

What is the worst state for senior healthcare?

Louisiana ranks last in the Commonwealth Fund’s Medicare scorecard and in America’s Health Rankings’ 2026 Senior Report. Mississippi, Kentucky and Arkansas also rank in the bottom five of both studies.

Where does Florida rank for senior healthcare?

Florida ranks 40th overall in the Commonwealth Fund’s Medicare scorecard and 47th for quality of care. It does have the most Medicare Advantage plans of any state for 2027 (560) and one of the lowest average Medicare Advantage premiums ($2.13 a month).

Does Medicare work the same in every state?

Original Medicare (Part A and Part B) covers the same services in every state. Medicare Advantage plans, Part D plans and Medigap premiums vary by state and county, and some states have extra Medigap protections.

Does Medicare pay for long-term care?

No. Medicare doesn’t cover long-term custodial care. It covers up to 100 days of skilled nursing facility care after a qualifying 3-day hospital stay. Medicaid, long-term care insurance or your own savings usually pay for custodial care.

When can I change my Medicare plan for 2027?

Medicare open enrollment runs October 15 to December 7, 2026. If you’re in a Medicare Advantage plan, you can also switch once between January 1 and March 31, 2027. Moving out of your plan’s service area gives you a special enrollment period.

Sources

• Commonwealth Fund, State Scorecard on Medicare Performance, Appendices (October 2025)
• America’s Health Rankings, 2026 Senior Report State Rankings
• CMS, 2027 Medicare Open Enrollment State Fact Sheets (September 28, 2026)
• CMS, Medicare Advantage and Part D Expected to Remain Stable in 2027
• CareScout, Cost of Care Survey 2025
• CMS Provider Data, Nursing Home State and US Averages
• Medicare.gov, Long-Term Care
• California Department of Insurance, Medigap Birthday Rule