Thinking of Moving? Here Are the Best and Worst States for Health Care

For older people, including those contemplating a move to warmer locations on a part-time basis, much consideration should be given to the ins and outs of health care and health insurance in places outside their home states.

Credit: Mackenzie Weber

Lately, nothing – not even the pandemic – has stopped older Americans from migrating to the Sun Belt. In 2020 and 2021, that was true of those who:

• Sped up retirement sooner than transplants from past years
• Took advantage of being able to relocate and work remotely in less-frigid climates
• Traded colder locations (due to fears of greater exposure to the coronavirus in densely populated metro areas) for less-populous, warmer environments

And in 2019, when William H. Frey of The Brookings Institution analyzed U.S. Census Bureau data from 2012 to 2017, the data showed the Arizona metropolitan area of Phoenix, Mesa and Scottsdale experienced the largest migration numbers for people 55-and-older. Florida was the state with the largest annual average net migration for that age group.

HealthCareInsider.com, a HealthCare.com company, recently compared 28 metrics for the New York and Florida health care systems covering quality, access, providers and cost. Its analysis notes that people under 65 who relocate across state lines should remember that, in most cases, they can't bring their health insurance with them and must enroll in a new plan when leaving their home state.

However, says Jeff Smedsrud, president of insurance at HealthCare.com, "since original Medicare is a federal program, it can cross state lines."

But, he added, if the individual has a Medicare supplement plan, "they should enroll in their primary state of residence where they will get most of their care. If they need to see a doctor in Florida, a Medicare supplement will cover treatment since it follows the federal Medicare program." This is not the case, he added, "if the person has a [private insurer's] Medicare Advantage plan. … If you go outside of the network, your costs will be higher, or won't be paid at all." 

Health Care Insider's comparison of New York and Florida's health care systems shows mixed results. Most patients in both states gave high marks to their hospitals and their experience communicating with doctors. However, Floridians spent less time waiting in emergency rooms while living farther from hospitals than their New York counterparts.

The comparison also notes that costs for medical procedures — including gall bladder removals, knee/hip replacements and renal failure — are substantially higher in Florida.

"Our study shows that patients can potentially save by having procedures done in New York, where costs tend to be lower," Smedsrud says. "But costs can vary dramatically from provider to provider within each state. So patients should look carefully at costs of elective procedures where they have options to choose where to get service done."

And for transplants from the Empire State, says Smedsrud, "these newly minted Floridians should also prepare for lower access to health care – in distance to hospitals, insurance coverage and per capita-provider ratios – and higher costs."

Smedsrud said people with low incomes "should consider their health care coverage prior to moving to Florida due to the lack of Medicaid expansion… Florida was supposed to place Medicare expansion on the 2020 ballot, but it has been delayed until 2022." 

Health Care Insider plans to explore other migration patterns of health care in other parts of the Sun Belt. According to the Kinder Institute for Urban Research, The Sun Belt comprises 15 states: Alabama, Arizona, Arkansas, California, Florida, Georgia, Louisiana, Mississippi, Nevada, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

A study published in the August issue of American Economic Review concluded that some locations within and outside the Sun Belt enhance longevity more than others.The research team analyzedrecords of 6.3 million Medicare beneficiaries from 1999 to 2014, focusing on U.S. residents between ages 65 and 99.

Co-authored by MIT economist Amy Finkelstein, "Place-Based Drivers of Mortality: Evidence From Migration" found that many urban areas on both coasts – including New York City, San Francisco and Miami – have positive effects on longevity for older transplants moving there. The same was true for some major Midwestern cities such as Chicago.

According to the study, "Areas with favorable place effects on life expectancy tend to have less pollution, less extreme summer and winter temperatures, fewer homicides and fewer automobile fatalities. They also tend to have higher income and education, which could reflect either greater demand for quality health care."

On the other hand, the study found, a significant portion of the Deep South and the Sun Belt encompassing much of Alabama, Arkansas, Louisiana and northern Florida negatively affects longevity for older arrivals. That's also the case for much of the Southwest, including sections of Texas, Oklahoma, New Mexico and Arizona.

The study referenced an assertion by Harvard professor and author David M. Cutler. "Behavior is the key," he said. "When we compare geographic regions, the dominant factor driving health differences is how Americans behave. Unhealthy areas smoke more, drink more and eat to excess; healthier areas avoid these behaviors."

Constance Brossa has always been partial to storytelling. Her affinity for narratives developed when she was in grade school and remains to this day. A newspaper writer and editor for nearly a dozen years, she left the newsroom to launch an independent editing/writing service that evolved into a marketing agency with a focus on brand storytelling. She continues to write for, and edit, trade publications and digital media sites. Read More