1. Kentucky

Score: 100/100
The Bluegrass State takes the title of best state for older adult health care thanks to its high rankings for Medicare accessibility and costs, quality of Medicare-approved services and general health care costs. However, it ranks poorly (45 out of 50) in terms of overall health care quality and outcomes.

Kentucky ranks:

• First for quality of care in Medicare-certified hospices.
• Fifth for quality of care in Medicare-certified home health services.
• Third lowest in home health care costs.
• Fifth highest in number of hospital beds per 100,000 older adults.
• Ninth highest 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.

2. North Carolina

Score: 98.52/100
Snagging second place, North Carolina is one of the best states for older adult health care, as it ranks third for Medicare accessibility and costs, third for quality of Medicare-approved services and ninth for its density of health care providers. However, similar to Kentucky, it ranks poorly (44 out of 50) in terms of overall health care quality and outcomes. It also ranks seventh worst in terms of its average annual growth in Medicare personal expenditures (2021 to 2022).

North Carolina ranks:

• Ninth highest for the number of Medicare Advantage plans available.
• Seventh lowest for the average monthly out-of-pocket maximum of Medicare Advantage plans.
• Third for quality of care in Medicare-certified hospices (tying with Alabama).
• Fourth lowest for the cost of having a heart attack.

3. Alabama

Score: 98.12/100
A close third, Alabama stands out as another great state for senior health care thanks to its high number of Medicare Part D plan options (tying for first place with Tennessee), as well as its quality of care offered by Medicare-certified home health services (tying for second place with Louisiana).

Alamaba ranks:

• Third for quality of care in Medicare-certified hospices (tying with North Carolina).
• Fourth for the lowest average annual premiums cost for health insurance coverage.
• Second lowest for the cost of in-home care.
• Third lowest for the cost of assisted living facility care.

4. Georgia

Score: 95.94/100
The Peach State earns a respectable fourth place by having the second lowest costs of assisted living facility care, as well as the fourth highest number of insurance companies that provide Medicare plans for older adults.

Georgia ranks:

• Fifth lowest for the average monthly out-of-pocket maximum of Medicare Advantage plans.
• Sixth highest 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
• Seventh for the quality of care offered in Medicare-certified inpatient rehabilitation facilities.

5. Hawaii

Score: 88.80/100
Rounding out the top five, Hawaii ranks fifth due to having the highest number of geriatricians per 100,000 older adults across all 50 states. It also maintains the second lowest number of adults who report having obesity, as well as the second lowest mortality rates for both diabetes and cancer.

Hawaii ranks:

• Best of all states in terms of its mortality rate for both respiratory diseases and heart disease.
• Best of all states in terms of its average cost of annual deductibles for health insurance coverage.
• Best of all states with the lowest number of unplanned hospital readmissions.

6. Iowa

Score: 82.99/100
This Midwestern locale ranks as the sixth best state for older adult health care. It’s fourth best in terms of timeliness of care and has the fourth lowest number of people who choose to not see a doctor due to the costs of care.

Iowa ranks:

• Best of all states in terms of its cost of having a heart attack.
• Best of all states in terms of the cost of audiologist care.
• Third for quality of care in Medicare-certified hospices.
• Fourth for its number of Medicare Part D plan options.

7. Nebraska

Score: 81.63/100
Similar to Iowa, Nebraska takes a seat in the top 10 states for older adult health care by ranking second highest in terms of its timeliness of care. It also maintains the sixth highest number of mental health counselors per 100,000 people.

Nebraska ranks:

• Eighth lowest for the cost of nursing home facility care.
• Fourth lowest for the costs of preventative care.
• Fourth lowest for the cost of geriatric psychiatry care.

8. Arkansas

Score: 79.56/100
Arkansas can be a supportive state for older adult health care, as it maintains the lowest costs of both preventative care and geriatric psychiatry care. However, the Natural State does have the second highest diabetes mortality rate and the fourth highest Alzheimer’s disease mortality rate.

Arkansas ranks:

• Second lowest for the cost of audiologist care.
• Fourth lowest for the cost of assisted living facility care.
• Fifth lowest for the cost of nursing home facility care.
• Sixth highest for quality of care in Medicare-certified home health services.

9. Texas

Score: 74.99/100
Provider networks are bigger in Texas, earning the Lone Star State ninth place for health care for older adults. It maintains the eighth highest number of dentists per 100,000 older adults and the third highest number of Medicare-accepting physicians and practitioners per 100,000 older adults.

Texas ranks:

• Third lowest for its depression mortality rate.
• Second lowest for the cost of nursing home facility care.
• Fourth highest for its number of Medicare Part D prescribers.
• Second lowest for the average Medicare Advantage monthly premium cost.
• Third highest for the number of Medicare Advantage plans available.

10. Pennsylvania

Score: 73.77/100
Completing the top 10 states for older adult health care, Pennsylvania maintains the fifth highest number of Medicare-accepting physicians and practitioners per 100,000 older adults, as well as the sixth highest number of geriatricians per 100,000 older adults.

Pennsylvania ranks:

• Sixth lowest for its Alzheimer’s disease mortality rate.
• Eighth lowest for its average annual deductible cost for health insurance coverage.
• Lowest in terms of its average annual growth in Medicare personal expenditures (2021 to 2022).
• Seventh highest for quality of care in Medicare-certified hospital outpatient departments and ambulatory surgical centers services.

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.

The online survey of 2,000 general population U.S. adults was commissioned by Forbes Advisor and conducted by Talker Research, whose team members are members of the Market Research Society (MRS) and the European Society for Opinion and Marketing Research (ESOMAR). The survey was conducted in accordance with the MRS’s code of conduct. Data was collected from July 23 to July 29, 2024. The margin of error is ± 2.2 points with 95% confidence.

To determine which states are the best and worst for older adult health care, Forbes Advisor conducted a data analysis of 41 metrics spanning five categories: Medicare accessibility and costs, quality of Medicare services, health care costs, quality and outcomes of health care and density of health care providers. Data was collected across all 50 states, excluding Washington, D.C. See the full breakdown of the data analysis below.

Note: Alaska doesn’t provide access to Medicare Advantage plans. As a result, the state lacked data across metrics that measured Medicare Advantage coverage specifically.

1. Medicare Accessibility and Costs: 20%

• Average Medicare Advantage monthly premium (3%): Data from Centres for Medicare and Medicaid Services (CMS)
• Number of Medicare Advantage Plans (3%): Data from CMS
• Numbers of plans that offer Medicare Advantage beneficiaries who receive low-income subsidies and/or chronically ill beneficiaries additional options (1%): Data from CMS
• Number of Medicare Part D plans (1.5%): Data from CMS
• Number of Medicare Part D prescribers (1.5%): Data from CMS
• Average monthly out-of-pocket maximum of Medicare Advantage plans (3%): Data from CMS
• Number of health insurance companies providing Medicare Advantage plans (2%): Data from CMS.
• Preventative care costs (3%): Data from CMS
• Geriatric psychiatry costs (2%): Data from CMS

2. Quality of Medicare Services: 20%

• Quality of care in Medicare-certified home health services (4%): Data from CMS
• Quality of care in Medicare-certified hospices (4%): Data from CMS
• Quality of care in Medicare-certified hospital outpatient departments and ambulatory surgical centers services (4%): Data from CMS
• Quality of care in Medicare-certified inpatient rehabilitation facilities (4%): Data from CMS
• Unplanned hospital readmissions (4%): Data from CMS

3. Health Care Costs: 20%

• How much people spend on health care (2%): Data from CMS
• Average annual growth in Medicare personal expenditures, 2021 – 2022 (2%): Data from CMS
• Average annual premiums (2%): Data from KFF
• Average annual deductibles (2%): Data from KFF
• Hearing loss/cost of audiologist appointments (2%): Data from Sidecar Health
• Heart attack (2%): Data from Sidecar Health
• Cancer (2%): Data from NCBI
• Average cost of home health aid (2%): Data from Genworth
  • Note: “Home health aid” costs weren’t available for Hawaii, so “homemaker services” were used for this metric.
• Average cost of assisted living facilities (1%): Data from Genworth
• Average cost of nursing home facilities (1%): Data from Genworth
• Number of people who choose not to see a doctor due to costs (2%): Data from the Centers for Disease Control and Prevention (CDC)

4. Quality and Outcomes of Health Care: 20%

• Heart disease mortality rate (2.22%): Data from the CDC
• Cancer mortality rate (2.22%): Data from the CDC
• COVID-19/Respiratory diseases mortality rate (2.22%): Data from CDC
• Alzheimer’s disease mortality rate (2.22%): Data from CDC
• Fall mortality rate (2.22%): Data from CDC
• Diabetes mortality rate (2.22%): Data from CDC
• Depression mortality rate (2.22%): Data from CDC
• Obesity rate (2.22%): Data from CDC
• Timeliness of care (2.22%): Data from CDC

5. Density of Health Care Providers: 20%

• Number of geriatricians per 100,000 adults 60+ (3.33%): Data from The American Geriatrics Society
• Number of hospitals per square mile (3.33%): Data from the American Hospital Directory
• Number of hospital beds per 100,000 older adults (3.33%): Data from DataUSA
• Medicare physicians and practitioners per 100,000 older adults (3.33%): Data from CMS
• Number of mental health counselors per 100,000 people (3.33%): Data from DataUSA
• Dentists per 100,000 Older Adults (3.33%): Data from CDC