Rural Health
Resources by Topic: Medicare Advantage
September 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2025 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 2025 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 healthcare 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 healthcare 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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Most Medicare Advantage Markets are Dominated by One or Two Insurers
Examines the competitiveness of Medicare Advantage (MA) markets at the county level. Explores how often one or two Medicare Advantage insurers enrolled at least half of all enrollees within a county. Compares data on the share of counties in very concentrated MA markets across urban, rural adjacent, and rural non-adjacent counties.
Author(s): Nicole Zhu, Jeannie Fuglesten Biniek, Nolan Sroczynski, Tricia Neuman
Date: 07/2025
Sponsoring organization: KFF
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Examines the competitiveness of Medicare Advantage (MA) markets at the county level. Explores how often one or two Medicare Advantage insurers enrolled at least half of all enrollees within a county. Compares data on the share of counties in very concentrated MA markets across urban, rural adjacent, and rural non-adjacent counties.
Author(s): Nicole Zhu, Jeannie Fuglesten Biniek, Nolan Sroczynski, Tricia Neuman
Date: 07/2025
Sponsoring organization: KFF
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Payment Source Shift for Surgical Care Among Veterans Enrolled in Medicare Advantage Plans
Examines the likelihood of veterans enrolled in Medicare Advantage (MA) plans to shift payments for inpatient surgical care from MA to the Veterans Health Administration (VHA). Analyzes 54,754 inpatient surgeries of VHA enrollees to observe payment trends, with data broken down by demographics, insurance characteristics, region, and rurality.
Author(s): Winta T. Mehtsun, Yanlei Ma, Ellen Latsko, et al.
Citation: JAMA Health Forum, 6(6)
Date: 06/2025
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Examines the likelihood of veterans enrolled in Medicare Advantage (MA) plans to shift payments for inpatient surgical care from MA to the Veterans Health Administration (VHA). Analyzes 54,754 inpatient surgeries of VHA enrollees to observe payment trends, with data broken down by demographics, insurance characteristics, region, and rurality.
Author(s): Winta T. Mehtsun, Yanlei Ma, Ellen Latsko, et al.
Citation: JAMA Health Forum, 6(6)
Date: 06/2025
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2025
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Iowa Community Health Centers and Value-Based Care
Describes how Iowa Primary Care Association (Iowa PCA) and two sister organizations, IowaHealth+ and INConcertCare, pursued value-based care opportunities before joining the Medicare Shared Savings Program. Discusses the network's Medicaid value-based care contract; a partnership with Main Street Health to expand value-based contracting and provide more comprehensive, integrated primary care to patients with Medicare Advantage; data analytics; strategic planning and roadmaps; and next steps.
Date: 06/2025
Sponsoring organization: Rural Health Value
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Describes how Iowa Primary Care Association (Iowa PCA) and two sister organizations, IowaHealth+ and INConcertCare, pursued value-based care opportunities before joining the Medicare Shared Savings Program. Discusses the network's Medicaid value-based care contract; a partnership with Main Street Health to expand value-based contracting and provide more comprehensive, integrated primary care to patients with Medicare Advantage; data analytics; strategic planning and roadmaps; and next steps.
Date: 06/2025
Sponsoring organization: Rural Health Value
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Most People in the Most Rural Counties Get Medicare Coverage from Traditional Medicare
Examines the percentage of eligible Medicare beneficiaries with traditional Medicare versus Medicare Advantage at the county level in 2024. Compares type of Medicare coverage by rural non-adjacent, rural adjacent, and urban county classification.
Author(s): Jeannie Fuglesten Biniek, Meredith Freed, Nolan Sroczynski, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Examines the percentage of eligible Medicare beneficiaries with traditional Medicare versus Medicare Advantage at the county level in 2024. Compares type of Medicare coverage by rural non-adjacent, rural adjacent, and urban county classification.
Author(s): Jeannie Fuglesten Biniek, Meredith Freed, Nolan Sroczynski, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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