United States · Medicare Advantage · Research

Which States Have the Worst Medicare Advantage Plans for 2027?

By Best Worst Insurance Editorial TeamUpdated October 18, 2026

Where you live decides how good a Medicare Advantage plan you are likely to be in. We took every person in a rated Medicare Advantage contract in October 2026, placed them in their state using CMS's state and county enrollment file, and gave each the 2027 rating of the contract they are in ^[1,2]. In Rhode Island, Nebraska and Oregon, fewer than four in ten members are in a contract rated four stars or more. In Utah it is 97%, and in Puerto Rico every rated member is. New York and Georgia, two of the biggest markets, both rank in the bottom seven. This page ranks 48 states, DC and Puerto Rico; Alaska and Wyoming have too few members in rated contracts to rank fairly.

Best Worst Insurance Key Takeaways

Rhode Island is worst: 35% of 139,973 members are in a four-star contract, and its largest, Blue Cross & Blue Shield of Rhode Island's H4152, is rated 3.5 ^[1,2].
Nebraska (36%) and Oregon (38%) follow. In both, the largest contract is a UnitedHealthcare plan rated 3.5 ^[1,2].
Of the big markets, New York ranks fourth worst at 45% and Georgia seventh at 50% ^[1,2].
Utah (97%), Montana (93%), New Hampshire (92%), North Carolina (90%) and Florida (89%) are the best-rated states; Puerto Rico has every rated member at four stars or more ^[1,2].
In 13 of the 50 places ranked, fewer than 60% of members are in a four-star contract, against 71% nationally ^[1,2]^[3].

How we know: Members per state come from CMS's October 2026 Medicare Advantage enrollment by state, county and contract, in its abridged form, which leaves out county rows of ten or fewer people. Each member gets their contract's 2027 overall rating from CMS's Star Ratings data tables (8 October 2026). Unrated contracts are left out. States with fewer than 20,000 members in rated contracts, Alaska and Wyoming, are not ranked. The average is weighted by members. A committed script produces the table from the CMS files. Full methodology →

Every state ranked by share of Medicare Advantage members in a 4-star plan, worst first

October 2026 members in rated contracts, by state, with their contracts' 2027 ratings ^[1,2]. The last column is the contract with the most members in that state.

Rank (1 = worst)	State	Members in rated contracts	Members at 4+ stars	Average stars (by member)	Largest contract
1	Rhode Island	139,973	35%	3.68	Blue Cross & Blue Shield of Rhode Island H4152, 3.5 stars
2	Nebraska	128,026	36%	3.60	UnitedHealthcare H2802, 3.5 stars
3	Oregon	464,648	38%	3.64	UnitedHealthcare H3805, 3.5 stars
4	New York	2,129,203	45%	3.69	Healthfirst Medicare Plan H3359, 3.5 stars
5	North Dakota	53,226	46%	3.58	Medica H2450, 3 stars
6	Tennessee	819,720	47%	3.78	BlueCross BlueShield of Tennessee H7917, 3.5 stars
7	Georgia	1,139,644	50%	3.89	Humana H5216, 4 stars
8	Louisiana	556,979	55%	4.00	Humana H1951, 4.5 stars
9	Maine	230,161	56%	3.89	Martin's Point Generations Advantage H5591, 3.5 stars
10	New Mexico	215,729	56%	3.66	Presbyterian Health Plan H3204, 3 stars
11	Kansas	196,009	56%	3.85	UnitedHealthcare H2802, 3.5 stars
12	Washington	768,496	59%	3.94	UnitedHealthcare H3805, 3.5 stars
13	Missouri	748,356	59%	3.93	UnitedHealthcare H2802, 3.5 stars
14	South Dakota	61,302	60%	3.67	Medica H2450, 3 stars
15	Idaho	151,836	60%	3.66	UnitedHealthcare H4604, 4 stars
16	Arizona	805,794	61%	3.88	UnitedHealthcare H0609, 4 stars
17	Arkansas	317,983	61%	3.91	UnitedHealthcare H2001, 4.5 stars
18	Hawaii	136,001	62%	3.78	HMSA Akamai Advantage H3832, 3 stars
19	Connecticut	375,806	64%	3.98	Aetna Medicare H5522, 4.5 stars
20	Delaware	82,389	64%	3.78	UnitedHealthcare H5253, 4 stars
21	Alabama	699,444	64%	3.95	Blue Cross and Blue Shield of Alabama H0104, 4 stars
22	Ohio	1,386,451	65%	3.93	UnitedHealthcare H5253, 4 stars
23	Indiana	570,408	66%	3.88	UnitedHealthcare H2406, 4 stars
24	Virginia	676,532	66%	3.89	Anthem HealthKeepers H3447, 3 stars
25	Maryland	295,870	66%	3.87	Kaiser Permanente H2172, 4.5 stars
26	Vermont	20,373	69%	3.91	HealthSpring H7787, 3 stars
27	Kentucky	554,302	69%	3.91	Humana H5216, 4 stars
28	Texas	2,706,696	72%	3.98	UnitedHealthcare H0609, 4 stars
29	California	3,661,700	73%	4.03	Kaiser Permanente H0524, 4.5 stars
30	Pennsylvania	1,646,422	73%	4.06	Aetna Medicare H5522, 4.5 stars
31	Mississippi	292,318	74%	3.94	Humana H5216, 4 stars
32	Iowa	217,710	74%	3.87	Aetna Medicare H1609, 4 stars
33	South Carolina	568,556	75%	4.05	UnitedHealthcare H2001, 4.5 stars
34	Minnesota	687,465	75%	3.94	Blue Cross and Blue Shield of Minnesota H5959, 4 stars
35	West Virginia	243,346	75%	3.99	Humana H5216, 4 stars
36	Massachusetts	487,940	78%	3.97	Tufts Health Plan H2256, 4 stars
37	New Jersey	716,547	79%	4.18	Aetna Medicare H5522, 4.5 stars
38	Nevada	328,621	80%	4.03	Humana H6622, 4 stars
39	Wisconsin	758,873	81%	3.93	UnitedHealthcare H5253, 4 stars
40	Oklahoma	345,093	81%	4.02	UnitedHealthcare H5253, 4 stars
41	Illinois	997,507	82%	4.06	Aetna Medicare H5522, 4.5 stars
42	Michigan	1,419,117	85%	4.18	Blue Cross Blue Shield of Michigan H9572, 4.5 stars
43	District of Columbia	33,744	87%	4.00	UnitedHealthcare H2406, 4 stars
44	Colorado	560,810	88%	4.04	UnitedHealthcare H0609, 4 stars
45	Florida	3,067,116	89%	4.15	Humana H1036, 4.5 stars
46	North Carolina	1,344,331	90%	4.06	UnitedHealthcare H5253, 4 stars
47	New Hampshire	105,853	92%	4.11	Humana H5216, 4 stars
48	Montana	79,926	93%	4.04	Humana H5216, 4 stars
49	Utah	269,217	97%	4.08	UnitedHealthcare H4604, 4 stars
50	Puerto Rico	682,615	100%	4.85	MCS Classicare H5577, 5 stars

50 rows — scroll inside the table to read them all.

1. Why the same ratings give such different states

A contract's star rating is national: UnitedHealthcare's H2802 is 3.5 stars in Nebraska and 3.5 in Kansas. What changes by state is which contracts people are in. A state ranks low when its largest contracts happen to be rated below four, and that is the pattern at the bottom of the table: in Rhode Island, Nebraska, Oregon and Tennessee, the single largest contract is rated 3.5 ^[1,2].

2. The bottom of the table

Rhode Island's largest contract is Blue Cross & Blue Shield of Rhode Island's H4152, at 3.5. In Nebraska, Kansas and Missouri the largest is UnitedHealthcare's H2802, which fell from 4 stars to 3.5 this year ^[1,4,5]. In Oregon and Washington it is UnitedHealthcare's H3805, also 3.5, and Oregon is home to all three of ATRIO Health Plans' 2.5-star contracts. North and South Dakota's largest contract is Medica's H2450, at 3 stars.

New York and Georgia are the large markets in trouble. New York's biggest contract, Healthfirst's H3359, fell from 4.5 to 3.5; Georgia lost four large contracts from 4 stars to 3.5. Both are covered in detail: New York and Georgia.

3. The top of the table

Utah, Montana and New Hampshire rank highest among the states, with 92% to 97% of members at four stars or better, and Puerto Rico, where two five-star contracts dominate, is at 100% ^[1,2]. Florida, the second-largest market, is sixth best at 89%; see Florida. California and Texas sit in the middle, at 73% and 72%; see California and Texas.

4. What it means for you

If you live in a state near the top, most of the large plans around you are well rated, and the choice turns on price and doctors. If you live near the bottom, it is worth checking your own contract in the 2027 lookup, and looking at the five-star plans licensed in your state. The insurer ranking is on the Medicare Advantage hub, and the lowest-rated contracts nationally are on the worst-plans page.

Frequently asked questions

Which state has the worst Medicare Advantage plans?

Rhode Island, on 2027 ratings: 35% of its Medicare Advantage members are in a contract rated four stars or more, the lowest share of the 50 places we ranked. Nebraska (36%) and Oregon (38%) are next ^[1,2].

Which state has the best Medicare Advantage plans?

Among the 50 states, Utah, with 97% of members in four-star contracts. Puerto Rico, which we also rank, has 100% ^[1,2].

Does a low-ranked state mean my plan is bad?

No. The ranking describes where members are, not every plan on offer. Even in Rhode Island, a third of members are in a four-star contract, and the plans sold in your county may differ. Check your own contract in the 2027 star ratings lookup.

Sources

Every figure on this page is footnoted to one of the primary documents below. Reliability tiers: A = regulator, court or filed document; B = reputable publisher or carrier official page; C = user-generated (reported by users).

1.Centers for Medicare & Medicaid Services — 2027 Part C and D Star Ratings data tables (Summary Ratings, Low Performing and High Performing Contracts, Domain and Measure Stars), 8 October 2026. https://www.cms.gov/files/zip/2027-star-ratings-data-tables-oct-8-2026.zipTier A · Regulator / court / filed document · Published 2026-10-08 · Accessed 2026-10-18
2.Centers for Medicare & Medicaid Services — Monthly MA Enrollment by State/County/Contract, October 2026 (abridged version, rows of 10 or fewer enrollees excluded). https://www.cms.gov/files/zip/ma-enrollment-state-county-contract-october-2026-abridged-version-exclude-rows-10-or-less-enrollees.zipTier A · Regulator / court / filed document · Published 2026-10-15 · Accessed 2026-10-18
3.Centers for Medicare & Medicaid Services — Fact sheet — 2027 Medicare Advantage and Part D Star Ratings, 8 October 2026. https://www.cms.gov/files/document/fact-sheet-2027-ma-part-d-star-ratings-october-8-2026.pdfTier A · Regulator / court / filed document · Published 2026-10-08 · Accessed 2026-10-18
4.Centers for Medicare & Medicaid Services — 2026 Part C and D Star Ratings data tables, Summary Ratings as updated 22 July 2026. https://www.cms.gov/files/zip/2026-star-ratings-data-tables.zipTier A · Regulator / court / filed document · Published 2026-07-22 · Accessed 2026-10-18
5.Centers for Medicare & Medicaid Services — Monthly Enrollment by Contract, October 2026. https://www.cms.gov/files/zip/monthly-enrollment-contract-october-2026.zipTier A · Regulator / court / filed document · Published 2026-10-15 · Accessed 2026-10-18