Vermont, Utah and Minnesota topped the Commonwealth Fund’s Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
The healthcare research foundation evaluated states on criteria spanning four domains: access to care, quality of care, costs and affordability, and population health. These performance indicators draw from CMS, federal surveys and other public data sources. The Commonwealth Fund ranked states according to how well Medicare was working based on those indicators. The organization mostly reviewed data from 2023 through 2025.
Plan availability, nonmedical supports and costs differ across states, which could contribute to variable Medicare experiences.
According to the report, the high-performing states tend to offer better coverage plans — like Medicare Advantage and more robust prescription drug plans — and are usually less stringent with prior authorization requirements. These states also have lower Medicare program spending per person and generally strong healthcare systems overall.
Here is how all 50 states, plus the District of Columbia, performed:
1. Vermont
2. Utah
3. Minnesota
4. Rhode Island
5. Colorado
6. New Hampshire
7. Maine
8. Hawaii
9. Delaware
10. Massachusetts
11. Washington
12. Connecticut
13. Wisconsin
14. North Carolina
15. Nebraska
16. Pennsylvania
17. Maryland
18. Iowa
19. Idaho
20. Arizona
21. North Dakota
22. Virginia
23. Oregon
24. South Dakota
25. Ohio
26. Michigan
27. Kansas
28. South Carolina
29. New Jersey
30. District of Columbia
31. California
32. Indiana
33. Nevada
34. Missouri
35. New York
36. Montana
37. Illinois
38. Wyoming
39. Tennessee
40. Florida
41. Alaska
42. Georgia
43. New Mexico
44. Alabama
45. West Virginia
46. Texas
47. Arkansas
48. Oklahoma
49. Kentucky
50. Mississippi
51. Louisiana
