Access to Care for Rural Medicare Beneficiaries

Research center:
Project funded:
September 2018
Project completed:
December 2019

Access to timely, appropriate, and affordable healthcare is important for health outcomes and overall well-being. Access to care is partially determined by access to insurance coverage to help make such care affordable and attainable. Because Medicare provides nearly-universal insurance coverage for older adults in the U.S., as well as for some non-elderly adults with disabilities, access to care should in theory be guaranteed for individuals with Medicare coverage. However, there is ample evidence showing that some Medicare beneficiaries—including rural residents—still struggle to access care when they need it. Rural Medicare beneficiaries face particular hurdles in accessing care, including longer distances to healthcare facilities, lower median incomes, fewer supplemental Medigap and Medicare Advantage plan options, higher disability rates (leading to greater need), and healthcare workforce shortages.

Given these differences, current information is needed about access to care for rural Medicare beneficiaries in order to inform policies and programs to ensure the best possible healthcare access and health outcomes. National in scope this project has relevance for policy making and healthcare delivery at the federal, regional, state, and local levels.

The sample included Medicare beneficiaries from across the country and was weighted to generate nationally-representative estimates. Key informants were selected from each of the four census regions to ensure national coverage. We analyzed rural-urban differences in multiple dimensions of access to care, including use of routine and preventive care, as well as difficulty getting necessary care due to concerns about cost, coverage type, inability to find a provider, difficulty with transportation, and difficulty with scheduling; analyzed within-rural differences in multiple dimensions of access to care by coverage type, rurality, region, health status, and socio-demographic characteristics; described the experiences of rural safety net providers in helping to provide access to care for Medicare beneficiaries; and identified policy and programmatic interventions to improve access to care for rural Medicare beneficiaries. In primary data collection, we asked key informants about their experiences providing safety net care to rural Medicare beneficiaries, including their perceptions the most challenging aspects of accessing care. We also asked them about potential policy and programmatic interventions. We coded the interviews to identify themes and policy implications.