Rural Health
Resources by Topic: Medicare Advantage
Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries
Discusses the differences in barriers to care and preventive care utilization for older adults enrolled in traditional Medicare versus Medicare Advantage and makes a rural-urban comparison. Explores barriers to care, such as quality of care and out-of-pocket costs, as well as care utilization, such as regular vaccinations, cancer screenings, and cholesterol tests, among others.
Author(s): Gawain J. Williams, Dan M. Shane, Whitney E. Zahnd, Keith J. Mueller
Date: 11/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Discusses the differences in barriers to care and preventive care utilization for older adults enrolled in traditional Medicare versus Medicare Advantage and makes a rural-urban comparison. Explores barriers to care, such as quality of care and out-of-pocket costs, as well as care utilization, such as regular vaccinations, cancer screenings, and cholesterol tests, among others.
Author(s): Gawain J. Williams, Dan M. Shane, Whitney E. Zahnd, Keith J. Mueller
Date: 11/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Payment Basics: Medicare Advantage Program Payment System
Overview of Medicare payments to Medicare Advantage (MA) local and regional plans discussing the methods for determining Medicare payments to both plans.
Date: 11/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments to Medicare Advantage (MA) local and regional plans discussing the methods for determining Medicare payments to both plans.
Date: 11/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries
Explores how provider networks vary across Medicare Advantage plans and when compared to traditional Medicare. Examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries by analyzing Medicare Advantage provider directories for 2022. Includes information on the availability of physicians to Medicare Advantage enrollees and traditional Medicare beneficiaries in rural counties.
Author(s): Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, Karen Pollitz
Date: 10/2025
Sponsoring organization: KFF
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Explores how provider networks vary across Medicare Advantage plans and when compared to traditional Medicare. Examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries by analyzing Medicare Advantage provider directories for 2022. Includes information on the availability of physicians to Medicare Advantage enrollees and traditional Medicare beneficiaries in rural counties.
Author(s): Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, Karen Pollitz
Date: 10/2025
Sponsoring organization: KFF
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Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers
Examines the availability of behavioral health providers in selected Medicare Advantage (MA) and Medicaid managed care networks in 2023. Analyzes provider network lists and MA and Medicaid encounter data for four MA and two Medicaid managed care plans from 10 selected urban and rural counties across five states. Describes the proportion of the behavioral health workforce in each county included in the plans' networks. Discusses the extent to which managed care plans had inactive providers in their network and why these providers did not deliver services to enrollees. Includes data on the percentage of inactive providers in rural and urban counties. Offers recommendations to monitor and improve the accuracy of provider networks.
Additional links: Report Highlights
Date: 10/2025
Sponsoring organization: Office of Inspector General (HHS)
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Examines the availability of behavioral health providers in selected Medicare Advantage (MA) and Medicaid managed care networks in 2023. Analyzes provider network lists and MA and Medicaid encounter data for four MA and two Medicaid managed care plans from 10 selected urban and rural counties across five states. Describes the proportion of the behavioral health workforce in each county included in the plans' networks. Discusses the extent to which managed care plans had inactive providers in their network and why these providers did not deliver services to enrollees. Includes data on the percentage of inactive providers in rural and urban counties. Offers recommendations to monitor and improve the accuracy of provider networks.
Additional links: Report Highlights
Date: 10/2025
Sponsoring organization: Office of Inspector General (HHS)
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Unfairness Toward Rural Beneficiaries in Medicare's Hierarchical Conditions Categories Score
Evaluates the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) to determine its usefulness in accurately predicting risk for rural and urban patients. Assesses rural and urban risk by mortality rates and compares findings with HCC's measure of spending to identify risk. Discusses implications of findings related to reimbursement rates, healthcare access, social determinants of health, and Medicare Advantage enrollment. Offers potential solutions to address study findings.
Author(s): Ravi B. Parikh, Kristin A. Linn, Junning Liang, et al
Citation: Health Affairs Scholar, 3(9)
Date: 09/2025
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Evaluates the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) to determine its usefulness in accurately predicting risk for rural and urban patients. Assesses rural and urban risk by mortality rates and compares findings with HCC's measure of spending to identify risk. Discusses implications of findings related to reimbursement rates, healthcare access, social determinants of health, and Medicare Advantage enrollment. Offers potential solutions to address study findings.
Author(s): Ravi B. Parikh, Kristin A. Linn, Junning Liang, et al
Citation: Health Affairs Scholar, 3(9)
Date: 09/2025
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September 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare payment operations and improving payment accuracy, a discussion with the Comptroller General of the United States regarding the Government Accountability Office's work related to improper payments in the Medicare program and opportunities to improve program sustainability, Medicare's overall financial situation, access to hospice and services under the Medicare hospice benefit for beneficiaries with end-stage renal disease or cancer, and the relationship between changes in Medicare Advantage enrollment and hospital finances.
Date: 09/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare payment operations and improving payment accuracy, a discussion with the Comptroller General of the United States regarding the Government Accountability Office's work related to improper payments in the Medicare program and opportunities to improve program sustainability, Medicare's overall financial situation, access to hospice and services under the Medicare hospice benefit for beneficiaries with end-stage renal disease or cancer, and the relationship between changes in Medicare Advantage enrollment and hospital finances.
Date: 09/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Comparing Utilization of Home Health Care Between Traditional Medicare and Medicare Advantage Beneficiaries by Rural-Urban Status
Policy report describing differences in utilization of home health care between beneficiaries enrolled in Traditional Medicare (TM) and Medicare Advantage (MA), and by rural or urban status. Examines differences in use of home health overall, provision of specific services, including physical and occupational therapy, and receipt of care from home health agencies by enrollment in TM and MA. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas.
Date: 09/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Policy report describing differences in utilization of home health care between beneficiaries enrolled in Traditional Medicare (TM) and Medicare Advantage (MA), and by rural or urban status. Examines differences in use of home health overall, provision of specific services, including physical and occupational therapy, and receipt of care from home health agencies by enrollment in TM and MA. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas.
Date: 09/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Rural Beneficiary Access to Medicare Advantage-Part D Plans
Policy brief updating RUPRI's analysis of Medicare Advantage-Part D plans (MA-PDs) including enhanced benefit plan availability and differences in characteristics across metropolitan, micropolitan, and noncore areas. Features statistics including number of MA-PDs and stand-alone prescription drug plans (PDPs), average monthly premium costs, and availability in metropolitan, micropolitan, and noncore areas from 2008-2023.
Author(s): Edmer Lazaro, Dan M. Shane, Fred Ullrich, Keith Mueller
Date: 08/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Policy brief updating RUPRI's analysis of Medicare Advantage-Part D plans (MA-PDs) including enhanced benefit plan availability and differences in characteristics across metropolitan, micropolitan, and noncore areas. Features statistics including number of MA-PDs and stand-alone prescription drug plans (PDPs), average monthly premium costs, and availability in metropolitan, micropolitan, and noncore areas from 2008-2023.
Author(s): Edmer Lazaro, Dan M. Shane, Fred Ullrich, Keith Mueller
Date: 08/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Advantage Enrollees Account for 25% of all Inpatient Hospital Days
Describes the growth of Medicare Advantage (MA) as a share of hospital inpatient days between 2013 and 2022. Presents data from hospital cost reports submitted to the Centers for Medicare & Medicaid (CMS) regarding the share of inpatient days attributable to MA compared to traditional Medicare, the percentage of hospitals with more inpatient days from Medicare Advantage than traditional Medicare, and the variation across hospitals within counties. Compares trends in the share of inpatient days for MA enrollees across urban; rural, adjacent to a metro area; and rural, not adjacent to a metro area hospitals.
Author(s): Jamie Godwin, Jeannie Fuglesten Biniek, Zachary Levinson, Tricia Neuman
Date: 08/2025
Sponsoring organization: KFF
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Describes the growth of Medicare Advantage (MA) as a share of hospital inpatient days between 2013 and 2022. Presents data from hospital cost reports submitted to the Centers for Medicare & Medicaid (CMS) regarding the share of inpatient days attributable to MA compared to traditional Medicare, the percentage of hospitals with more inpatient days from Medicare Advantage than traditional Medicare, and the variation across hospitals within counties. Compares trends in the share of inpatient days for MA enrollees across urban; rural, adjacent to a metro area; and rural, not adjacent to a metro area hospitals.
Author(s): Jamie Godwin, Jeannie Fuglesten Biniek, Zachary Levinson, Tricia Neuman
Date: 08/2025
Sponsoring organization: KFF
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The Rapid Growth Of Medicare Advantage Poses Challenges To Rural Hospitals
Commentary describing key features of Medicare Advantage (MA) and how they may interact with the unique limitations of rural hospitals. Offers policy recommendations to align MA expansion with rural hospital sustainability.
Author(s): James D. Lee, Cody L. Mullens, Adam A. Markovitz, Janice Probst
Citation: Health Affairs Forefront
Date: 07/2025
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Commentary describing key features of Medicare Advantage (MA) and how they may interact with the unique limitations of rural hospitals. Offers policy recommendations to align MA expansion with rural hospital sustainability.
Author(s): James D. Lee, Cody L. Mullens, Adam A. Markovitz, Janice Probst
Citation: Health Affairs Forefront
Date: 07/2025
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