Comparing Care-Seeking Patterns Among Rural Medicare Fee-for-Service and Medicare Advantage Beneficiaries

Medicare Advantage (MA) enrollment has grown steadily in rural areas, reshaping where and how Medicare beneficiaries receive care. Unlike traditional Fee-for-Service (FFS) Medicare, MA plans may impose narrower networks, prior authorization requirements, and distinct cost-sharing structures that influence patients' decisions about which hospitals and clinics to use. These features may interact with geographic distance and limited local capacity in rural communities to change whether beneficiaries obtain care close to home or travel to more distant facilities.

This study will describe and compare care-seeking patterns among rural beneficiaries enrolled in traditional FFS Medicare and MA. Using recent Medicare claims and encounter data, linked to plan characteristics files and Rural-Urban Commuting Area (RUCA) codes, we will identify each beneficiary's nearest hospital and primary care provider and define bypass as receiving care at a more distant facility. We will estimate how often bypass occurs, how far beneficiaries travel when bypassing local care, and which types of hospitals and clinics (for example, Critical Access Hospitals, prospective payment hospitals, rural and urban referral centers, primary care practices) serve as destinations.

Analyses will compare bypass rates and travel distance between traditional FFS Medicare and MA beneficiaries, examine differences by MA plan type and region, and describe the types of services and diagnoses most commonly associated with care outside the local area. Findings will inform policymakers, health systems, and plans about how Medicare payment and network structures affect access to care and the financial viability of rural health care providers.