Quality, cost of Medicare coverage vary by state, report finds

The quality and cost of Medicare coverage depend on where you live, according to new research.

The Commonwealth Fund, a research nonprofit focused on health care, on Thursday released a report grading how well Medicare works for people in each state and the District of Columbia. The federally funded health insurance program covers about 68 million Americans who are at least 65 years old, and an additional 7 million with disabilities.

Medicare ostensibly provides the same coverage to all enrollees, but how individuals experience that coverage differs by state, researchers found.

"In some states, beneficiaries can see doctors quickly and afford their prescriptions," Gretchen Johnson, vice president at the Commonwealth Fund, said in a statement. "In others, they face higher costs, delays or red tape."

Vermont, Utah and Minnesota ranked at the top in the report's rankings, while Louisiana, Mississippi and Kentucky landed at the bottom.

Researchers scored states based on 31 indicators, including demographic data like age and income, as well as factors including having a usual care provider, preventable hospital stays, and the share of beneficiaries with potentially dangerous medication prescriptions.

For example, the share of hospital admissions in West Virginia that could have been avoided with quality outpatient care was more than double the share in Idaho.

Costs vary, too. Because traditional Medicare does not cover prescription drugs, people on Medicare usually purchase separate drug plans or purchase drug coverage as part of a Medicare Advantage plan.

But those out-of-pocket costs differ depending on where a person lives. Older people in North Dakota pay nearly 13% of their drug costs out of pocket, compared with people in New York who pay less than 5%, the report found.

High-performing states such as Vermont and Utah tend to share certain characteristics. Most have Medicare Advantage and prescription drug plans that offer better coverage than plans in other states. They're also more likely to not require prior authorization for preventive services and specialty care.

Higher performing states also tend to have a health care system that performs well for people who aren't covered by Medicare. States at the bottom of the rankings, such as Louisiana and Mississippi, have a much higher share of people who were uninsured or underinsured before they enrolled in Medicare.

"When people are sick coming into Medicare, they tend to be really sick when they're on Medicare," David Radley, a senior scientist at the Commonwealth Fund, told reporters on a press call earlier this week. "So if somebody is un- or underinsured before they age into Medicare, that might mean they have chronic diseases that may not necessarily be getting treated. They may be people that don't get to see the doctor very often because they're un- or underinsured.

"Then, when they age into Medicare, they can be much sicker on average than Medicare beneficiaries in other states."