About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing healthcare. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance.

This study provides detailed information about rural-urban differences among adults under age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act. Rural adults were more likely than urban adults to report problems paying their medical bills and to delay or forego needed care because of cost. To control costs, rural adults were more likely to skip medication doses, take less medicine, delay filling prescriptions, or ask their physician for a lower cost prescription than urban adults.