Rural-Urban Differences in Medicare Advantage Plan Quality Scores

This project focused on rural-urban differences in access to, and enrollment in, Medicare Advantage (MA) plans with four- and five-star quality ratings. The results included comparisons across geography and across types of MA plans [Health Maintenance Organization (HMO), HMO vs Preferred Provider Organization (PPO), PPOs, or other types].

Data for this analysis were drawn primarily from the Centers for Medicare and Medicaid Services (CMS) website, including plan offerings by county, characteristics of those plans, star ratings of the plans, and enrollment in the plans, supplemented by additional sources as needed. The project analyzed:

1. The percent of plans offered in each county that are 4- or 5-star rated, including zero percent if there are none. Researchers used that number to compare across the three geographic categories.
2. The percentages of rural and urban HMO and PPO enrollment by MA plan star rating.
3. Differences in race/ethnicity across counties in different levels of plan offerings, and in plan offerings from MA plans with 4- or 5-star ratings.
4. The quality by quintile of rural enrollment, i.e. rank all the plans (or contracts) by percent rural enrollment, then calculate enrollment-weighted stars within each quintile, and explore potential drivers of differences, including which star domains were lower that drove an overall lower value.

Publications

• Trends in Medicare Advantage Quality for Nonmetropolitan Enrollees, 2019-2023
  Policy Brief
  RUPRI Center for Rural Health Policy Analysis
  Date: 05/2026
  This brief analyzes Medicare Advantage star rating data for 2019 to 2023 for all (non-special needs) contracts and describes patterns across geography, by region, and by plan type.