States With the Best Hospital Quality Ratings: CMS Data

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CMS 2026 Overall Hospital Quality Star Ratings reveal sharp geographic divides in hospital performance across the country. Some states consistently produce four- and five-star hospitals while others cluster at the bottom. Here is what the data actually shows.

The 2026 CMS Overall Hospital Quality Star Ratings cover 3,204 rated hospitals nationally, and the distribution is uneven enough to matter when you are deciding where to live. Only 6.4% of hospitals earn one star, but nearly 30% earn four stars, meaning location plays a real role in your odds of landing in a high-quality facility.

How CMS Star Ratings Work

The Centers for Medicare and Medicaid Services publishes Overall Hospital Quality Star Ratings annually through its Care Compare tool on Medicare.gov. Ratings run from one to five stars and are calculated from up to 46 measures across five categories: mortality, safety of care, readmission, patient experience, and timely and effective care.

Not every hospital receives a rating. Facilities must meet minimum reporting thresholds, so smaller critical access hospitals are often excluded. The 2026 national distribution breaks down as follows: 204 hospitals (6.4%) earned one star, 670 (20.9%) earned two stars, 991 (30.9%) earned three stars, 953 (29.8%) earned four stars, and the remaining share earned five stars.

Which States Produce the Most Top-Rated Hospitals

States in the Upper Midwest and parts of the Mountain West consistently place a higher share of their hospitals in the four- and five-star tier. Wisconsin, Minnesota, Nebraska, and Utah have historically had above-average concentrations of high-rated facilities relative to their total hospital counts. These states tend to have lower uncompensated care burdens, stronger rural hospital funding, and mature regional health systems that perform well on readmission and mortality metrics.

Florida and Texas both have large absolute numbers of high-rated hospitals simply due to scale, but their statewide averages are closer to the national median. California shows significant variation, with major academic medical centers in the four- and five-star range sitting alongside lower-rated safety-net hospitals in urban cores.

The 2026 CMS data also includes a notable finding about VA hospitals. Seventy-eight percent of VA hospitals that received an Overall Hospital Quality Star Rating earned four or five stars, and VA facilities account for 15% of all five-star hospitals nationally. If you are a veteran, that concentration of high-rated facilities is a meaningful location factor.

Where Hospital Quality Is Weakest

States with the highest concentration of one- and two-star hospitals include parts of the Deep South and certain rural regions of the mid-Atlantic. Mississippi, Alabama, and Arkansas have historically struggled with hospital quality metrics, driven by high rates of chronic disease in their populations, limited specialty care access, and thinner margins that make quality improvement investments harder to sustain.

New York presents a more complicated picture. The state has world-class academic medical centers in Manhattan that earn top marks, but many community hospitals downstate and in rural upstate regions rate at two or three stars. Averaging across all rated hospitals in New York produces a middling statewide score despite its reputation for medical excellence.

This gap matters practically. If you are relocating and your ZIP code puts you 45 minutes from a one-star hospital and three hours from a five-star facility, that is the care reality you are accepting.

What This Means for Where You Live

Hospital quality is not just a health consideration. It is a financial one. A botched procedure or a preventable readmission can produce tens of thousands of dollars in out-of-pocket costs, lost income, and long-term care expenses. For retirees especially, proximity to high-rated hospitals is one of the most consequential location factors that gets underweighted against taxes and cost of living.

If you are already comparing states on tax exposure, it is worth running both calculations together. A state with no income tax but a cluster of two-star hospitals within reasonable driving distance may cost you more in health outcomes than the tax savings are worth. Our state comparison calculator lets you layer healthcare access data alongside tax rates and cost of living figures so you can see the full picture.

For retirees weighing states like Florida or Tennessee for their tax advantages, see our breakdown of the best states for retirees to avoid taxes. And if healthcare costs in retirement are a concern, the tax treatment of your income in that state matters too. Our post on states that don't tax Social Security covers which states let you keep more of your fixed income, which directly affects how much you can spend on healthcare.

You can look up any specific hospital's current rating directly through CMS Care Compare at Medicare.gov.

Key Takeaways

The 2026 CMS ratings cover 3,204 hospitals. Only 6.4% earned one star, while 29.8% earned four stars, so geography shapes your realistic access to quality care.
VA hospitals earned four or five stars at a 78% rate in 2026, and they represent 15% of all five-star hospitals nationally, a significant advantage for veterans choosing where to settle.
States in the Upper Midwest, including Wisconsin, Minnesota, and Nebraska, consistently place above the national average in four- and five-star hospital concentration, while parts of the Deep South cluster at the low end.

Compare your target states side by side on hospital quality, taxes, and cost of living at liveordiehere.com.

Sources

Where to confirm these figures

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