Kentucky Medicare recipients have some of the worst health outcomes in the country. That’s according to a report released Thursday by healthcare research foundation the Commonwealth Fund.
The study ranks Kentucky as having the third worst overall Medicare performance, topped only by Mississippi and Louisiana. It takes into account access, quality and affordability of care and the health of the population that Medicare serves. Medicare covers just over one in five Kentuckians, primarily those 65 and older, although it also covers certain younger people with disabilities and illnesses.
The Commonwealth Fund President Dr. Joseph Betancourt said that, despite older Americans being the most “securely insured” group, the report shows deep disparities in care depending on where you live.
“Yet despite being a national program, this scorecard reveals that where you live often shapes your experience, how easy it is to see a doctor, afford prescriptions, or avoid preventable hospital stays,” Betancourt said. “The report uncovers wide gaps in health care access, cost, and quality, and clearly shows that Medicare, while a vital safety net for millions of Americans, is not working the same for everyone.”
Using data from 2023 through 2025, the scorecard compares states on categories like what percent of older adults went without a dental visit in the past year — Kentucky’s rate was nearly 40%, 11 percentage points higher than the national average. More than half of Kentuckians’ Medicare Advantage plans require prior authorization before specialist or preventative care visits.
Kentucky Medicare beneficiaries also exceeded the national average for potentially avoidable emergency department visits and hospital readmissions.
The report authors also noted that higher costs did not generally equal better outcomes. While Kentucky ranked 40th in terms of affordability, the state scored even worse for population health. According to the report, 4.7% of adults 65 or older went without care because of the cost in the past year.
“We found that spending does not always align with health outcomes,” Betancourt said. “In at least some states with relatively high per beneficiary spending, life expectancy at age 65 was lower than in many states with lower spending.”
The report found that, as of 2023, roughly two in three Medicare recipients were diagnosed with three or more chronic conditions and 40% of older Kentuckians reported difficulty dressing, running errands, walking or concentrating — both higher than the national average.
Older Kentuckians were also more likely to report feeling lonely or lacking emotional support than in other states. Kristen Kolb, a research associate with the Commonwealth Fund, said that loneliness can increase the risk of hospital readmissions and higher health care costs.
“Loneliness can have negative health effects and has been linked with poor health outcomes, like increased risk of heart disease and stroke,” Kolb said. “In my experience as a registered nurse, I have witnessed firsthand the impact that loneliness can have on older adults' health status.”
Gretchen Jacobson, the vice president of Medicare at the Commonwealth Fund, called for more federal policy aimed at improving care and incentivizing providers to “apply best practices and reduce wasteful spending and care.”
“State policymakers also have a role in improving a state's health care infrastructure and setting policies to improve clinical practice norms,” Jacobson 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.”
