Louisiana and Mississippi rank last in serving Medicare recipients, a new study shows.
People in both states who are covered by the federal health insurance program that primarily serves older adults have more trouble accessing and affording care than those in other states, and the quality of care they receive is lower, according to a report released Thursday by the Commonwealth Fund, a private foundation that studies health care access in the U.S.
Medicare costs in Louisiana and Mississippi are some of the highest in the nation, but do not correspond to better health outcomes for patients. The states’ life expectancies at 65 are some of the lowest in the country, according to federal data. Mississippi comes in last place, with people living two years shorter than the national average.
Lower ranking states have weaker overall health infrastructure, a trend across Southeastern states, said Gretchen Jacobson, the Commonwealth Fund’s vice president for Medicare.
The report used 31 metrics to assess each state’s care, including strictness of prior authorization policies, access to outpatient care and how much beneficiaries pay.
About 650,000 Mississippians and 960,000 Louisianans – over 20% of each state’s population – are enrolled in Medicare, according to data from the Centers for Disease Control and Prevention. The program provides coverage to nearly all people 65 years or older and covers some younger people with disabilities.
Sixty-nine million Americans are enrolled in Medicare, making it the largest payer for health care in the country. The program was established in 1965 by President Lyndon B. Johnson to provide health insurance to older Americans. It has changed over the last six decades, expanding eligibility to more people and offering additional benefits, like prescription drug coverage and Medicare Advantage plans.
Private companies run Medicare Advantage plans and provide an alternative to traditional Medicare. About half of Medicare beneficiaries are enrolled in such plans.
Medicare was designed to deliver uniform benefits to older Americans regardless of where they live, but states differ widely in their delivery of quality care, the report authors said.
“We have more work to do to ensure it delivers the care equally and effectively for people in every state,” said Dr. Joseph Betancourt, president of the Commonwealth Fund, during a press conference Wednesday
Some disparities stem from how the program is structured, because Medicare relies on private providers to deliver care, said Mark Diana, associate dean for research and graduate programs at the University of West Florida who has researched health policy and management.
“All of the variations in how private medical care is provided across the country exist in the Medicare program, just like everywhere else,” Diana said.
While coverage may be the same across states, the services that patients are able to access may differ.
In Louisiana and Mississippi, older Medicare recipients are prescribed medications that should be avoided in the elderly at higher rates than in other states, according to the report. Such medications increase the risk of confusion, falls, bleeding risk and other potential harms.
Nursing home residents who are hospitalized are readmitted to the hospital more frequently in Louisiana and Mississippi, and avoidable emergency room visits are more common,the report said.
Patients are sicker when they enroll in Medicare in Louisiana and Mississippi, where there are high rates of uninsurance and poverty, said David Radley, a senior scientist for the Commonwealth Foundation, during a press conference Wednesday. For example, more than two out of three Medicare beneficiaries in Mississippi and Louisiana have three or more chronic conditions, like diabetes or high blood pressure.
“When people are sick coming into Medicare, they tend to be really sick when they’re in Medicare,” Radley said.
Research has shown that people who are uninsured before age 65 have higher health care costs when they enroll in Medicare.
Improving health care systems’ ability to care for people of all ages will enhance care for Medicare recipients, Jacobson said.
Even with the support of Medicare, older people in Mississippi and Louisiana struggle to afford the costs of health care. More Medicare recipients in Mississippi and Louisiana went without care because they couldn’t afford it in the past year than in most other states.
Experts say the Medicaid spending cuts passed this summer in the One Big Beautiful Bill Act may impact low-income Medicare beneficiaries, many of whom are enrolled in both programs.
Cuts to Medicaid may make it more difficult for dually enrolled beneficiaries to access services that aren’t required to be provided by traditional Medicare plans, like dental care or home and community-based services, Jacobson said.
More than a third of Mississippians and Louisianans over 65 went without a dental visit in the past year, the report said.
The legislation also imposed a moratorium on changes that aimed to reduce enrollment barriers for Medicare Savings Programs, which allow Medicaid to pay Medicare premiums and other costs for low-income beneficiaries. These changes will not be implemented until 2034.
The open enrollment period for Medicare Advantage and Part D prescription drug plans runs Oct. 15 to Dec. 7.
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