Rural Working-Age Adults Report More Cost Barriers to Health Care


Using the 2019-2020 National Health Insurance Survey, this study examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults (ages 18-64). Given that individuals in fair or poor health are more likely to report affordability problems, these barriers may also translate into worse outcomes by exacerbating poor health.

Key Findings:

  • Rural adults were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost.
  • Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed.
  • For all affordability measures, adjusted analyses showed that rural adults who were uninsured, lower income, or in fair or poor health were more likely to experience affordability problems compared with other rural adults.
Maine Rural Health Research Center
Erika Ziller, Carly Milkowski, Amanda Burgess