Medicare Fee-for-Service Health Care Expenditures Among Rural and Urban Beneficiaries During 2009-2019

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01/2026

Centers for Medicare & Medicaid Services Medicare Geographic Variation Public Use files, the American Community Survey, and the Area Health Resource files were the data sources for research on whether, and to what extent, rural Medicare beneficiaries used health care differently from their urban counterparts from 2009-2019.

Key Findings:

• From 2009 to 2019, Medicare Fee-for-Service (FFS) beneficiaries in urban counties had consistently higher price-standardized total Medicare FFS spending compared to rural micropolitan and noncore counties, but the gap of Medicare FFS beneficiaries' spending between urban and rural noncore counties was closing.
• While Medicare FFS beneficiaries in rural and urban counties had similar spending trends, the level of spending differed in hospital inpatient and hospital outpatient services with urban beneficiaries spending more on hospital inpatient services and rural beneficiaries spending more on hospital outpatient services.
• The declining spending on hospital inpatient services among Medicare FFS beneficiaries across all county types (urban, rural micropolitan, rural noncore) coincided with an increase in spending on hospital outpatient services from 2011 to 2019, but inpatient spending declined more slowly after 2014.
• From 2012 to 2019 there were diverging trends between urban and rural noncore counties in per-beneficiary Medicare spending on post-acute care as urban beneficiaries experienced a declining trend on post-acute care spending and rural noncore beneficiaries experienced persistent, stable Medicare spending on post-acute care.

University of South Carolina Rural Health Research Center

Peiyin Hung, Theodoros Giannouchos, Xuanzi Qin, Masroora Tabassum, Elizabeth Crouch

Care management, Chronic diseases and conditions, Health services, Hospitals and clinics, Public health