Rural Health
Resources by Topic: Medicare
The Need for Medicare Dental Coverage
Details the oral health risks of limited dental coverage by Medicare. Discusses aging-related oral healthcare conditions, the economic barriers to care caused by lack of coverage, and how rurality can affect preexisting oral health disparities.
Date: 08/2025
Sponsoring organization: CareQuest Institute for Oral Health
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Details the oral health risks of limited dental coverage by Medicare. Discusses aging-related oral healthcare conditions, the economic barriers to care caused by lack of coverage, and how rurality can affect preexisting oral health disparities.
Date: 08/2025
Sponsoring organization: CareQuest Institute for Oral Health
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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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End-Stage Renal Disease Treatment Choices (ETC) Model: Third Annual Evaluation Report, Calendar Years 2021-2023
Evaluation of the End-Stage Renal Disease Treatment Choices (ETC) Model, incorporating analyses of home dialysis use, waitlisting for a kidney transplant, living donor and deceased donor transplantation, utilization of services, Medicare payments, and quality of care. Features results from interviews and surveys involving model participants and beneficiaries, and examines impacts of the first three years of the ETC Model, 2021-2023. Explores if the impacts of the ETC Model differed by patient subgroup, including rural residence.
Additional links: Appendices, Executive Summary, Findings at a Glance
Date: 08/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, The Lewin Group
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Evaluation of the End-Stage Renal Disease Treatment Choices (ETC) Model, incorporating analyses of home dialysis use, waitlisting for a kidney transplant, living donor and deceased donor transplantation, utilization of services, Medicare payments, and quality of care. Features results from interviews and surveys involving model participants and beneficiaries, and examines impacts of the first three years of the ETC Model, 2021-2023. Explores if the impacts of the ETC Model differed by patient subgroup, including rural residence.
Additional links: Appendices, Executive Summary, Findings at a Glance
Date: 08/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, The Lewin Group
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FY 2026 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and Quality Reporting (IPFQR) Updates Final Rule (CMS-1831-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 inpatient psychiatric facility (IPF) prospective payment system (PPS) final rule. Covers annual updates to the prospective payment rates, outlier threshold, and wage index. Also describes changes to facility-level adjustment factors for teaching status and rural location.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 inpatient psychiatric facility (IPF) prospective payment system (PPS) final rule. Covers annual updates to the prospective payment rates, outlier threshold, and wage index. Also describes changes to facility-level adjustment factors for teaching status and rural location.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Uncertain Future of Medicare's Stand-Alone Prescription Drug Plan Market and Why It Matters
Discusses the Medicare Part D stand-alone prescription drug plan (PDP) market and the Part D premium stabilization demonstration. Describes the impact of PDP market stability on rural Medicare beneficiaries. Explores the potential effects of the continuation of, or changes to, the premium stabilization program.
Author(s): Juliette Cubanski, Tricia Neuman
Date: 07/2025
Sponsoring organization: KFF
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Discusses the Medicare Part D stand-alone prescription drug plan (PDP) market and the Part D premium stabilization demonstration. Describes the impact of PDP market stability on rural Medicare beneficiaries. Explores the potential effects of the continuation of, or changes to, the premium stabilization program.
Author(s): Juliette Cubanski, Tricia Neuman
Date: 07/2025
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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Rural Hospitals and the Rural Health Transformation Program: What Comes Next
Blog post discussing the rural health transformation program established in the July 2025 budget reconciliation law. Describes potential priorities for states' use of the rural health transformation program funding. Outlines additional steps Congress could take to help rural hospitals serve their communities.
Author(s): Emma Sheffert, Maya Sandalow
Date: 07/2025
Sponsoring organization: Bipartisan Policy Center
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Blog post discussing the rural health transformation program established in the July 2025 budget reconciliation law. Describes potential priorities for states' use of the rural health transformation program funding. Outlines additional steps Congress could take to help rural hospitals serve their communities.
Author(s): Emma Sheffert, Maya Sandalow
Date: 07/2025
Sponsoring organization: Bipartisan Policy Center
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Use of Telebehavioral Health Services by Critical Access Hospitals in the United States: A Qualitative Study of the Impacts of Medicare Flexibilities and Future Opportunities
Analyzes interviews with 22 Critical Access Hospital (CAH) administrators and providers to identify how telebehavioral health is used in CAHs, the impact of Medicare billing flexibility, and opportunities and challenges for telebehavioral healthcare moving forward.
Author(s): Christopher M. Shea, Sharita Thomas, Marah Maaita, Heidi O'Connor, Yvonne Jonk
Citation: Digital Health, 11
Date: 07/2025
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Analyzes interviews with 22 Critical Access Hospital (CAH) administrators and providers to identify how telebehavioral health is used in CAHs, the impact of Medicare billing flexibility, and opportunities and challenges for telebehavioral healthcare moving forward.
Author(s): Christopher M. Shea, Sharita Thomas, Marah Maaita, Heidi O'Connor, Yvonne Jonk
Citation: Digital Health, 11
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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AHEAD CMS-Designed Medicare FFS HGB Calculator Tool for Acute Care Hospitals Demonstration
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool, which aims to support fee-for-service acute care hospitals in understanding the HGB financial methodology for the AHEAD Model. Discusses how an AHEAD Medicare Fee-for-Service Hospital Global Budget is constructed.
Additional links: AHEAD Model CMS-Designed Medicare FFS Acute Care Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Acute Care Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool, which aims to support fee-for-service acute care hospitals in understanding the HGB financial methodology for the AHEAD Model. Discusses how an AHEAD Medicare Fee-for-Service Hospital Global Budget is constructed.
Additional links: AHEAD Model CMS-Designed Medicare FFS Acute Care Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Acute Care Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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