Medicare Spending by State: A Complete Breakdown

Published February 2026 · 12 min read

The Big Picture

Across all 63 states and territories, Medicare paid a total of $854.8B to 10.6M providers between 2014 and 2023. But that spending is far from evenly distributed.

Top 5 States by Total Spending

Why Florida Punches Above Its Weight

Florida consistently ranks among the top states for Medicare spending — both total and per-provider. Several factors drive this:

• Demographics: Florida has the second-highest share of residents aged 65+ in the nation, creating a massive Medicare-eligible population.
• Provider density: South Florida, particularly Miami-Dade, has an exceptionally high concentration of Medicare providers.
• Fraud hotspot: The DOJ has consistently identified South Florida as a Medicare fraud epicenter, with billing patterns that inflate per-provider averages.
• Specialty mix: Florida has a higher proportion of high-billing specialties like ophthalmology and cardiology.

Highest Per-Provider Spending

Total spending is influenced by state size. Per-provider spending better reveals where Medicare dollars are most concentrated:

Lowest Per-Provider Spending

Complete State Rankings

Here's every state and territory ranked by total Medicare payments:

Regional Patterns

Medicare spending follows clear regional patterns:

• Sun Belt dominance: Florida, Texas, and California account for a disproportionate share of spending, driven by large retiree populations.
• Northeast concentration: New York, Pennsylvania, and New Jersey have high total spending and above-average per-provider payments.
• Rural states lag: States with more rural populations tend to have lower per-provider spending, partly reflecting fewer high-cost specialists and lower fee schedule adjustments.
• Territories at the bottom: U.S. territories (Puerto Rico, Virgin Islands, Guam) consistently show the lowest per-provider Medicare payments, reflecting different coverage dynamics and provider economics.

Read more: ZIP Code Lottery — Why Your Medicare Costs Depend on Where You Live →