Rural-Urban Differences in Health and Health Care Use Among Medicare Beneficiaries Under 65

In prior University of Minnesota Rural Health Research Center research projects, we have demonstrated rural-urban differences in the characteristics and health care use of Medicare beneficiaries, finding that rural Medicare beneficiaries tend to be in worse health and have more difficulty accessing health care than their urban counterparts. More recently (2024-2025), we had a research project focused on differences in health and access to care for rural and urban adults with disabilities, again finding significant differences between rural and urban residents in health and health care access. Some of our additional research projects have found differences by disability status among rural and urban adults in housing, living arrangements, and use of government assistance.

Altogether, these results suggest meaningful differences among Medicare beneficiaries and people with disabilities in health and health care access by rural-urban location. However, very little research has focused specifically on rural-urban differences among Medicare beneficiaries under age 65 (“non-elderly” Medicare beneficiaries). This is a notable gap, as non-elderly Medicare beneficiaries quality for Medicare because of severe disability and comprise approximately 10% of all Medicare beneficiaries and nearly 20% of all Medicare spending. As disability rates are higher among rural residents, and access to care is more challenging, more information is urgently needed about the health and health care access characteristics of non-elderly Medicare beneficiaries in order to best allocate resources to meet their needs.

This project will address these research gaps by answering the following questions:

1. What are the characteristics of rural vs. urban Medicare beneficiaries under age 65, including socio-demographic, health, and disability characteristics?
2. Are there differences in health care use and access between rural and urban Medicare beneficiaries under age 65? 2a) Do rural Medicare beneficiaries under age 65 differ from their rural counterparts age 65 and older in their use of and access to health care?
3. What are challenges and opportunities related to rural residents younger than 65 applying for and accessing Medicare?