Medicare Agent Scout research
The Medicare Language Gap: Where Older Americans Most Need Bilingual Medicare Help
Published 2026-06-20
Nearly 5 million Americans age 65 and older — about 8.7% — speak English less than “very well.” For people navigating Medicare’s deadlines and plan choices, that language barrier is a real obstacle to getting clear help. This analysis maps where the need is greatest, by state.
Key findings
- Nearly 5 million Americans age 65 and older — 8.71% — speak English less than “very well,” the federal definition of limited English proficiency (LEP). (Medicare Agent Scout analysis of U.S. Census ACS 2023 5-year, Table B16004; consistent with Justice in Aging, 2024.)
- Among Medicare beneficiaries specifically, about 1 in 12 (~8%) has limited English proficiency — roughly 4 million people. (CMS Office of Minority Health, 2023; Justice in Aging, 2024.)
- The need is geographically concentrated: 10 states have more than 10% of older adults with LEP — led by California, New York, Hawaii, New Jersey, Texas, and Florida — and about two-thirds of LEP Medicare beneficiaries live in just four states (California ~30%, New York ~13%, Florida ~12%, Texas ~11%). (MAS analysis of ACS 2023; CMS, 2023.)
- The gap centers on specific communities: about 55% of Hispanic and 49% of Asian Medicare beneficiaries have limited English speaking proficiency, compared with roughly 1–2% of White and Black non-Hispanic beneficiaries. (CMS, 2023.)
- It is also growing: about 10.4% of adults 51–64 have limited English proficiency — a cohort aging toward Medicare eligibility. (Census ACS via ACL, 2024.)
Where the language gap is concentrated
The table below ranks every state by the share of its population age 65 and older that speaks English less than “very well,” computed from U.S. Census ACS 2023 5-year data (Table B16004). 10 states exceed 10%. Figures are estimates; the ± value is the Census margin of error (90% confidence).
| # | State | % of 65+ with LEP | Est. people 65+ with LEP |
|---|---|---|---|
| 1 | California | 23.2% ±0.2 | 1,392,021 ±10,038 |
| 2 | New York | 16.7% ±0.2 | 578,496 ±7,243 |
| 3 | Hawaii | 15.8% ±0.6 | 45,445 ±1,702 |
| 4 | New Jersey | 14.5% ±0.3 | 226,294 ±3,886 |
| 5 | Texas | 13.9% ±0.2 | 544,838 ±6,755 |
| 6 | Florida | 12.5% ±0.2 | 580,594 ±7,451 |
| 7 | Nevada | 10.6% ±0.4 | 55,371 ±2,056 |
| 8 | Massachusetts | 10.5% ±0.2 | 128,070 ±2,857 |
| 9 | Rhode Island | 10.1% ±0.6 | 20,092 ±1,236 |
| 10 | New Mexico | 10.0% ±0.4 | 39,838 ±1,730 |
| 11 | Illinois | 9.8% ±0.2 | 206,716 ±3,868 |
| 12 | Connecticut | 9.0% ±0.3 | 58,524 ±2,113 |
| 13 | Arizona | 7.3% ±0.2 | 98,440 ±2,801 |
| 14 | Washington | 7.2% ±0.2 | 90,035 ±2,359 |
| 15 | Maryland | 6.9% ±0.2 | 69,115 ±2,307 |
| 16 | Alaska | 5.9% ±0.6 | 5,775 ±606 |
| 17 | Virginia | 5.5% ±0.2 | 77,185 ±2,276 |
| 18 | District of Columbia | 5.4% ±0.7 | 4,634 ±622 |
| 19 | Colorado | 4.6% ±0.2 | 40,502 ±1,806 |
| 20 | Georgia | 4.2% ±0.2 | 66,907 ±2,519 |
| 21 | Utah | 4.1% ±0.3 | 15,919 ±1,044 |
| 22 | Pennsylvania | 4.0% ±0.1 | 98,836 ±2,799 |
| 23 | Delaware | 3.9% ±0.4 | 7,921 ±744 |
| 24 | Oregon | 3.6% ±0.2 | 28,326 ±1,450 |
| 25 | Michigan | 3.2% ±0.1 | 58,588 ±1,931 |
| 26 | Minnesota | 3.0% ±0.1 | 29,259 ±1,339 |
| 27 | Kansas | 2.7% ±0.2 | 13,356 ±819 |
| 28 | North Carolina | 2.7% ±0.1 | 47,698 ±1,859 |
| 29 | Nebraska | 2.6% ±0.2 | 8,482 ±697 |
| 30 | Louisiana | 2.6% ±0.1 | 19,480 ±1,119 |
| 31 | Idaho | 2.4% ±0.2 | 7,650 ±742 |
| 32 | Oklahoma | 2.4% ±0.1 | 15,402 ±868 |
| 33 | New Hampshire | 2.2% ±0.3 | 6,065 ±677 |
| 34 | Ohio | 2.1% ±0.1 | 44,232 ±1,847 |
| 35 | Indiana | 1.9% ±0.1 | 21,791 ±1,228 |
| 36 | Wisconsin | 1.9% ±0.1 | 19,712 ±1,119 |
| 37 | South Carolina | 1.7% ±0.1 | 16,440 ±1,020 |
| 38 | Maine | 1.7% ±0.2 | 5,014 ±493 |
| 39 | Arkansas | 1.6% ±0.1 | 8,232 ±705 |
| 40 | Missouri | 1.6% ±0.1 | 16,716 ±1,107 |
| 41 | Tennessee | 1.5% ±0.1 | 18,082 ±1,213 |
| 42 | Iowa | 1.5% ±0.1 | 8,588 ±666 |
| 43 | Wyoming | 1.2% ±0.3 | 1,285 ±264 |
| 44 | Kentucky | 1.2% ±0.1 | 8,877 ±728 |
| 45 | Alabama | 1.1% ±0.1 | 10,132 ±871 |
| 46 | Vermont | 1.1% ±0.2 | 1,459 ±231 |
| 47 | North Dakota | 1.1% ±0.2 | 1,348 ±240 |
| 48 | South Dakota | 0.9% ±0.1 | 1,501 ±235 |
| 49 | Mississippi | 0.8% ±0.1 | 4,229 ±560 |
| 50 | Montana | 0.8% ±0.1 | 1,820 ±292 |
| 51 | West Virginia | 0.5% ±0.1 | 1,913 ±317 |
Source: U.S. Census Bureau, American Community Survey 2023 5-Year Estimates, Table B16004 (Medicare Agent Scout analysis). Includes the 50 states and the District of Columbia.
Who it affects
Limited English proficiency is not evenly distributed. According to the CMS Office of Minority Health (2023), about 55% of Hispanic and 49% of Asian Medicare beneficiaries have limited English speaking proficiency, compared with roughly 1–2% of White and Black non-Hispanic beneficiaries. Spanish is the most common language among older adults with LEP nationally, while Chinese, Vietnamese, Korean, and Tagalog are significant in specific states.
Why it matters for Medicare
Choosing Medicare coverage is a high-stakes, time-bound decision: enrollment periods have firm deadlines, and plans differ in their provider networks, drug coverage, and costs. Research from CMS and others links limited English proficiency to greater difficulty understanding coverage options and accessing care. When clear help isn’t available in a person’s language, the language barrier itself can shape which plan they end up with — or whether they get guidance at all.
What helps
Two things make a practical difference. First, being able to find a licensed Medicare agent who speaks your language — so you can ask questions and compare plans in the language you’re most comfortable in. Second, free counseling: every state has a State Health Insurance Assistance Program (SHIP), many of which offer language assistance, and you can reach Medicare directly at any time.
Find a licensed agent who speaks your language
Search Medicare Agent Scout by location and language, then contact the agent you choose. It’s free, and you decide who reaches out.
For free, unbiased help you can also contact your local SHIP at shiphelp.org, or Medicare directly at Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day, 7 days a week.
Methodology & sources
What this is. This study describes the language needs of the older-adult population using public federal data. It is not a measure of Medicare Agent Scout’s own listings or agents.
State table. For each state we used U.S. Census Bureau American Community Survey 2023 5-year estimates, Table B16004 (“Age by Language Spoken at Home by Ability to Speak English”). Within the 65-and-over panel, we summed the “speak English well / not well / not at all” cells across all non-English language groups and divided by the 65-and-over universe to get the share that speaks English less than “very well.” Margins of error were aggregated using the Census Bureau’s standard formulas (square root of summed squared MOEs for counts; the derived-proportion formula for percentages). Our computed national figure (8.71%) matches the published estimate.
Two different universes. Census ACS figures describe the population age 65 and older. CMS figures (the ~8% LEP and the four-state concentration) describe Medicare beneficiaries specifically — a related but different group. We label which is which throughout and do not combine them.
Sources.
- U.S. Census Bureau, ACS 2023 5-Year, Table B16004 — data.census.gov.
- CMS Office of Minority Health, 2023 (limited English proficiency among Medicare beneficiaries; disparities by race/ethnicity).
- Administration for Community Living / Justice in Aging, 2024 (older adults and limited English proficiency).
Cite this study
Medicare Agent Scout. “The Medicare Language Gap: Where Older Americans Most Need Bilingual Medicare Help.” 2026-06-20. https://medicareagentscout.com/research/medicare-language-gap