Choosing where you will live in retirement isn’t just about picking a state with low taxes and lots of sunshine. As the years go by, the odds go up that the health-care system will play a major role in your life—and the cost, quality and availability of health care varies dramatically. While some people consider health care when selecting a destination, their analysis rarely goes further than confirming there’s a well-regarded hospital nearby. While a state might have highly regarded hospitals, it also might impose relatively steep out-of-pocket costs on Medicare enrollees…or many doctors might not accept Medicare. ranked the 50 states plus the District of Columbia* on 24 measures related to quality, cost and accessibility of health care available to seniors. Among its findings…

Overall Rankings

First place: Minnesota

Last place: Oklahoma

Key takeaway: Whatever climate, region and population density you have in mind for your retirement destination, you can find a suitable state that offers top-tier senior health care.

When it comes to delivering health care to seniors, the two states at the very top of the rankings also are at the very geographic top of the country—Minnesota and North Dakota. These states receive high marks in a range of health-care–related measures…

North Dakota has the lowest ­prescription-drug prices and the ­fewest doctors who don’t accept Medicare. Minnesota has the second-highest ratio of home health aides per capita and the third-highest life expectancy. If those brisk Midwestern locales aren’t what you have in mind, warm Hawaii and California make the top 10…as do wealthy Northeastern states Massachusetts and Connecticut…mountain meccas Colorado and Montana…and two more Midwestern options—Nebraska and Iowa. The main connection among these states: Most made an effort to improve their health-care systems in the 1980s and 1990s, suggesting that state government initiatives can improve health-care quality, but doing so takes time.

Worst states for senior health care: Oklahoma, Georgia, DC, Mississippi, Louisiana, West Virginia, North Carolina, Alabama, Tennessee and South Carolina.

If you’re wondering about popular retirement destinations that aren’t in the top or bottom 10, Maine lands at 12…Arizona at 15…New Mexico at 18…Vermont at 19…Florida at 23…Texas at 35…and Nevada at 37.

Health-Care Costs

First place: Utah

Last place: DC

Key takeaway: High-cost-of-living states aren’t always high-cost-of-health-care states for seniors.

States with the lowest overall senior health-care costs include Utah, California, South Carolina, Kansas, Minnesota, Iowa, Arizona, Arkansas, New Mexico and North Dakota. It might come as a surprise to see California—known for its high costs—on that list, but senior health-care costs can be counterintuitive, with government subsidies and spending creating unexpected distortions.

Examples: North Carolina, California and Hawaii have the lowest prescription-drug prices—even though Hawaii and California are expensive places. California also has the lowest average Medicare Advantage maximum out-of-pocket amounts, followed by Wisconsin and North Dakota. And pricey New York and New Jersey take two of the four top spots on the list with the lowest average Medicare Part D deductibles, joining Missouri and Wisconsin.

More low health-care cost ­leaders: New Mexico and South Carolina have the lowest average monthly Medicare Supplement plan premiums…South Carolina and Arizona, the lowest average Medicare Advantage plan premiums…Utah and Arizona, lowest overall out-of-pocket medical spending per capita.

Least affordable health-care overall: DC, Delaware, West Virginia, Connecticut, Vermont, New York, Maryland, Alaska, Alabama and Georgia.

Overall Healthfulness

First place: Connecticut

Last place: Mississippi

Key takeaway: Consider health outcomes when evaluating a state’s health-care system, not just whether there’s a highly regarded hospital nearby.

Assessments often focus on the overall quality of a state’s hospitals. According to ratings from The Centers for Medicare & Medicaid Services, Hawaii, Delaware, Alaska and Idaho have the best public hospital systems, while Louisiana, Georgia, Texas and Oklahoma have the worst.

The overall quality of a state’s public hospital system doesn’t necessarily reflect the quality of a hospital that you would choose. Even states that have poorly regarded public hospital systems contain a few hospitals with strong reputations. Examples: Tulane Medical Center in New Orleans…Emory University Hospital in Atlanta…Houston Methodist Hospital in Houston…and St. Francis Hospital in Tulsa, Oklahoma are a few.

Perhaps the more meaningful measure of health-care quality is the outcomes of that state’s residents. Example: People live longest in Hawaii, California, Minnesota and New York…and die youngest in Mississippi, West Virginia, Alabama and Oklahoma. When you focus on the percentage of adults who have type-2 diabetes, the lowest rates are in Colorado, South Dakota and Montana…the highest in Alabama, West Virginia and Mississippi. As for the heart disease death rate—Minnesota, Massachusetts and Hawaii fare best…DC, Oklahoma and Mississippi worst.

When MedicareGuide grouped together seven factors that reflect on states’ general healthfulness, the top 10 were Connecticut, Massachusetts, New Jersey, Hawaii, New York, Colorado, Alaska, California, New Hampshire and Nebraska. The bottom 10 were Mississippi, Oklahoma, West Virginia, Alabama, Tennessee, Louisiana, Arkansas, Kentucky, South Carolina and Georgia.

Access to Health-Care

First place: Maine

Last place: Nevada

Key takeaway: Seniors should consider whether there’s an adequate supply of the health-care providers they might need later in retirement…and whether those providers accept Medicare.

Recent retirees may need a skilled nursing facility or home health aides down the road. Vermont, Maine and Idaho have the highest rate of skilled nursing facilities per capita…while New York, Virginia and North Carolina have the lowest. New York, Minnesota and DC are at the top of the list when it comes to home health aides per capita…while Florida, Georgia and Alabama land at the bottom.

Another measure: The share of doctors who accept Medicare. Top on this list are North Dakota, South Dakota and West Virginia…California, New York and Texas bring up the rear.

When the scores for nine senior-health-care-access-related factors were added up, Maine, Vermont, Minnesota, North Dakota, West Virginia, Connecticut, Nebraska and Iowa fared best. Note: Most of these states are relatively rural. Big cities may have prestigious hospitals, but you don’t have to sacrifice health care to retire to a rural low-population state.

Worst for health-care access: Nevada, Georgia, South Carolina, Utah, North Carolina, Virginia, Oklahoma, Texas.

For more information, see the study at Best States for Elderly Healthcare.

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