Rural Beneficiary Access to Medicare Advantage-Part D Plans

In 2023, there were nearly twice as many Medicare Advantage Prescription Drug (MA-PD) plans in metropolitan counties as in noncore counties, averaging about 29 plan choices for enrollees in metropolitan counties compared to 16 plans available to enrollees in noncore counties. This policy brief updates RUPRI's analysis of MA-PDs including enhanced benefit plan availability and variations in characteristics across metropolitan, micropolitan, and noncore areas.

Key Findings:

• A greater proportion of noncore counties (6.4 percent) do not offer any enhanced MA-PDs in comparison to micropolitan counties (5.6 percent) and metropolitan counties (3.9 percent). Enhanced MA-PDs may include additional coverage in the coverage gap, lower cost-sharing than standard coverage plans, or coverage of drugs excluded under Part D, but have higher premiums.
• The proportion of enhanced MA-PD plans offering additional coverage in the coverage gap is lower (58.0 percent) in noncore than in micropolitan counties (60.2 percent) and metropolitan counties (61.8 percent).
• The average monthly MA-PD premiums are slightly higher in noncore than in micropolitan and metropolitan counties. In 2023, the average monthly plan premiums were $17.85, $17.55, and $15.20 for noncore, micropolitan, and metropolitan counties, respectively. However, the proportion of MA-PDs with premiums below the regional benchmark is higher in noncore counties (3.9 percent) than in micropolitan counties (3.7 percent) and metropolitan counties (2.9 percent).
• The average MA-PD annual drug deductible is consistently higher in noncore counties ($152.49) than in micropolitan ($141.75) and metropolitan ($128.97) counties. Noncore counties have the largest proportion (11.5 percent) of MA-PDs with the highest annual drug deductible (set by Centers for Medicare & Medicaid Services in 2023 at $505). The proportion of MA-PDs with $0 annual drug deductibles is higher in metropolitan counties (55.5 percent) than in micropolitan (52.3 percent) or noncore counties (50.8 percent).