Location matters in real estate, and it matters just as much when it comes to accessing quality healthcare for older adults. Recent research highlights clear geographic differences in senior healthcare across the United States. In addition to the state rankings for long-term care services, a new analysis looks at which states — including Washington, D.C. — offer the best and worst overall healthcare for people 65 and older, considering both quality and affordability.
>> Related: A Look at State Rankings for Long-Term Care Services
How the rankings were determined
The analysis was conducted by MedicareGuide, part of HealthCare.com. It evaluated states across three primary categories: cost, access, and quality. Within those categories, the researchers used 24 specific metrics to capture a complete picture of senior healthcare. Metrics included average monthly insurance premiums, prescription drug prices, the number of nursing homes and assisted living facilities per capita, geriatricians per capita, Alzheimer’s disease rates, deaths due to falls, life expectancy, and other relevant indicators.
Data for the rankings were sourced from publicly available federal and health organizations, including the U.S. Census Bureau, the Bureau of Labor Statistics, the Kaiser Family Foundation, the Centers for Medicare & Medicaid Services (CMS), and the Centers for Disease Control and Prevention (CDC), among others.
The results reveal meaningful differences in how states perform for older residents.
Top 10 states for overall senior healthcare
- Minnesota
- North Dakota
- Massachusetts
- California
- Nebraska
- Hawaii
- Montana
- Colorado
- Iowa
- Connecticut
Bottom 10 states for overall senior healthcare
- Delaware
- South Carolina
- Tennessee
- Alabama
- North Carolina
- West Virginia
- Louisiana
- Mississippi
- Washington, D.C.
- Georgia
- Oklahoma
Patterns and persistent trends
About 22 percent of the U.S. population, roughly 62.8 million people, are enrolled in Medicare, the nationwide health insurance program for older adults established in 1965. While Medicare helps offset many medical costs, it does not eliminate geographic disparities in access, affordability, and outcomes for seniors.
When comparing the MedicareGuide results with earlier rankings of long-term care services, there is notable overlap: states that perform well on one measure often do well on the other. High-ranking states tend to have more integrated health systems, with strong primary care networks and coordinated specialty services. Many invested in improving access decades ago and continue to benefit from those systems today.
Conversely, lower-ranked states often include larger rural and low-income populations, which creates barriers to care. Limited access to primary care providers and specialists can mean conditions go undetected or worsen before treatment, driving worse outcomes and higher costs over time.
That said, statewide rankings do not tell the whole story. Even in states that rank poorly overall, there are excellent care providers and regions with strong health systems. For example, North Carolina ranks low on the overall list, yet areas such as the Research Triangle and Charlotte benefit from prominent university hospitals and integrated healthcare networks that provide high-quality senior care. These pockets of excellence often reflect local investments, provider density, and coordinated services that differ from rural or underserved parts of the same state.
>> Related: How Important Is It to Choose a Medicare-Certified Senior Care Center?
Why this matters for senior living decisions
Choosing where to live in retirement involves more than weather, taxes, or proximity to family. Access to affordable, high-quality healthcare is a crucial factor that can affect quality of life, longevity, and financial security. These rankings offer a data-driven perspective to help seniors and their families weigh healthcare access and costs alongside lifestyle preferences when making relocation or long-term care decisions.
Evaluating local healthcare infrastructure — including the availability of primary care physicians, specialists, geriatric services, and long-term care facilities — is an important step when considering senior living options. In many cases, a community’s healthcare resources will have a greater influence on a senior’s well-being than other considerations, making it a key factor in planning for the future.