How Much Does Medicare Cost by State? The Complete 2024 Guide

Published February 2026 · 12 min read · Based on 2023 CMS data (latest available)

Why Medicare Costs Vary So Much by State

Medicare is a federal program, but what it costs taxpayers depends enormously on where they live. Several factors drive these differences: the number of beneficiaries, local cost-of-living adjustments (Geographic Practice Cost Indices), provider density, specialty mix, and — critically — billing patterns.

Using the complete CMS Physician and Other Supplier Payment dataset, we analyzed every Medicare payment made to every provider in 2023. Here's what $854.8 billion looks like, state by state.

The Top 10 Most Expensive Medicare States

These ten states account for more than half of all Medicare physician payments:

Together, these 10 states received $427.7 billion — roughly 50% of all Medicare physician payments. California and Florida alone account for nearly $150 billion.

See the full 50-state ranking →

Per-Provider Costs: Where Medicare Pays the Most Per Doctor

Total spending tells one story. Per-provider spending tells another. States with fewer providers but high utilization — or states with aggressive billing patterns — stand out when you normalize the data.

Florida leads the nation at approximately $121,000 per provider in average Medicare payments — far above the national average of $49,700. This aligns with Florida's historic role as the epicenter of Medicare fraud, with 56 AI-flagged providers in our fraud detection model.

At the other end, Puerto Rico averages just $18,000 per provider — reflecting lower reimbursement rates and a different healthcare delivery model.

The Fraud Factor: Why Some States Cost More

Not all Medicare cost variation is legitimate. Our machine learning model — trained on 8,300+ confirmed fraud cases from the LEIE and DOJ databases — flagged 500 providers with billing patterns that match convicted fraudsters. These flagged providers cluster heavily in specific states:

The correlation between high per-provider spending and fraud flags is not coincidental. States where Medicare pays more per doctor tend to attract more fraud — or the fraud itself drives up the per-provider average.

Medicare Costs by Region

Regional patterns emerge clearly in the data. The Southeast (Florida, Georgia, the Carolinas) has the highest per-beneficiary costs, driven by an older population and higher utilization rates. The Northeast has high total spending but more providers, resulting in moderate per-provider costs. The Midwest tends toward lower costs across the board, while the West is dominated by California's massive spending.

Explore the interactive geographic spending map →

What Drives Medicare Costs: Specialty Mix

A state's specialty mix explains a lot. States with more ophthalmologists and oncologists tend to have higher per-provider costs because these specialties bill more per provider. Clinical laboratories can bill $1.9 million per entity on average, while nurse practitioners average just $26,000.

Compare specialty costs across states →

The Markup Problem

Providers submitted $3.22 trillion in charges to Medicare in 2023. Medicare actually paid $854.8 billion. The other $2.14 trillion was written off — a markup ratio of roughly 3.8x nationally. But some states see markups of 5x or more, particularly in wound care and drug administration codes.

Read more: The $2.1 Trillion Writeoff →

How to Look Up Medicare Costs in Your State

OpenMedicare makes it easy to explore Medicare spending in any state. You can:

• Browse all 50 states + DC with total payments, provider counts, and top specialties
• Search any provider to see their individual Medicare billing history
• Check the fraud watchlist for providers flagged by our AI model
• Compare states head-to-head on spending, fraud rates, and specialty mix

Methodology

This analysis uses the CMS Medicare Physician and Other Supplier Public Use File for calendar year 2023 — the most recent data available. It covers Part B fee-for-service claims and includes payments to physicians, nurse practitioners, physician assistants, clinical laboratories, and other suppliers. It does not include Part A (hospital inpatient), Part C (Medicare Advantage plan payments), or Part D (prescription drug plan) data.

All dollar figures represent actual Medicare payments (allowed amounts), not billed charges. Provider counts reflect unique National Provider Identifiers (NPIs) with at least one Medicare claim.