Kentuckians covered by Medicare have some of the worst health outcomes and access to care in the country, according to a national report released Thursday.
The first-of-its-kind report, “State Scorecard on Medicare Performance: How Medicare Is Working for Its Beneficiaries,” from the Commonwealth Fund, places Kentucky as the third-worst state for Medicare performance. Medicare is mostly for people who are at least 65, though some illnesses and disabilities qualify people for coverage before that age.
Researchers based their rankings on access to care, quality of care, costs and affordability of care and population health in 2023 and 2024. Mississippi and Louisiana were the only states ranked lower than Kentucky on these measures. The best-performing states were Vermont, Utah and Minnesota.
Dr. Joseph Betancourt, the Commonwealth Fund president, said during a Wednesday press call that “Medicare, while a vital safety net for millions of Americans, is not working the same for everyone.”
“Despite being a national program, the scorecard reveals that where you live often shapes your experience,” Betancourt said. “As a primary care physician, I know how important it is when patients can focus on healing instead of worrying about medical bills. Medicare makes that possible for millions, but we have more work to do to ensure it delivers the care equally and effectively for people in every state.”
Medicare beneficiaries in southeastern states — including Kentucky — were much more likely than the national average to get prescriptions considered generally “unsafe” for elderly patients, according to David Radley, a senior scientist with the Commonwealth Fund.
“These are medications that evidence tells us that should be avoided in the elderly when we compare to beneficiaries in other parts of the country,” he said.
“We also found that the rate of hospitalization from preventable causes, a measure that generally reflects inadequate disease management, is more than double the lowest ranked states compared to the top performing states,” Radley said. The national rate of preventable hospital admissions was 26.4 per 1,000 people in 2023, according to the report. In Kentucky, that was 31.5.
Other takeaways include:
- More Kentucky Medicare beneficiaries (66%) than the national average (62%) had three or more chronic conditions in 2023.
- In 2024, nearly 5% of adults in Kentucky older than 65 reported going without needed medical care because of cost. The national average is just under 4%.
- More Kentucky adults 65 and older (36%) report feeling lonely than the national average (34%).
- In 2023, the rate per 1,000 Medicare beneficiaries to have a preventable hospitalization was 31.5 in Kentucky and 26.4 nationwide.
Kristen Kolb, a registered nurse and research associate at the Commonwealth Fund, said those last two points are connected.
“Research has shown that loneliness is a risk factor for hospital readmissions and is associated with increased health care costs,” she said. “Loneliness or lack of emotional support, is a widespread issue affecting at least 1 in 4 older adults in every state where data was available. Loneliness can have negative health effects and has been linked with poorer health outcomes like increased risk of heart disease and stroke.”
Betancourt said meaningful social connections and their link to “strong cognitive function” are “critical,” especially for older adults. In 2024 the Centers for Disease Control and Prevention reported that loneliness can increase risk of heart disease, stroke, Type 2 diabetes, dementia and earlier death.
Gretchen Jacobson, the vice president of Medicare, Expanding Coverage and Access at the Commonwealth Fund, said policies at the federal and state levels can help address disparities by setting standards for private plans and incentivizing “providers to apply best practices and reduce wasteful spending and care.”
“Although Medicare is a national program, health outcomes, access to needed health care, the affordability of care and quality of care all vary widely for the people it covers, and some issues such as loneliness, affect many older adults no matter where they live,” she said. “The combination of state and federal health policy is what enables beneficiaries to get the health care they need, and ultimately affects their health outcomes and experiences with care.”