An Insurance Profile of Rural America: Chartbook


Over the past decade, health insurance coverage has changed in major ways in rural areas, with shifts towards public and publicly subsidized coverage among the nonelderly – Medicaid, Marketplace plans – and a shift towards Medicare Advantage among those eligible for Medicare. This chartbook covers findings on overall coverage (insured and uninsured rates), employer sponsored insurance, marketplace coverage, and Medicare and Medicaid coverage. The demographic and economic characteristics of rural persons and their coverage rates are described, as well as how coverage impacts health status, access to care, and costs.

Key Findings

  • Uninsured rates were higher in non-metropolitan areas (13.3 percent) than in metropolitan areas (10.8 percent) for the population younger than age 65, in 2019.
  • Between 2010 and 2019, the overall uninsured rate fell substantially in both non-metropolitan and metropolitan areas.
  • In both metropolitan and non-metropolitan areas, people of color had higher rates of uninsurance than non-Hispanic White persons, a gap which has persisted despite some gains in coverage for racial/ethnic minorities since the implementation of the Affordable Care Act.
RUPRI Center for Rural Health Policy Analysis
Timothy McBride, Emily Hernandez, Leah Kemper, Abigail Barker, Eliot Jost, Keith Mueller