Rural Health
Research Gateway

Private health insurance

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of "potential market" participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.
  • Affordable Insurance Exchanges and Enrollment: Meeting Rural Needs
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2012
    This report reviews the principal characteristics of exchanges that will affect how well they meet the needs of rural residents, including the structure, governance, and process for enrollment.
  • Affordable Insurance Exchanges: A Summary of Characteristics and Rural Implications
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2012
    This summary provides a quick reference to selected critical decisions being made about health insurance exchanges that will affect access to affordable insurance plans in rural America.
  • Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals With Serious Mental Illness (Findings Brief)
    WICHE Center for Rural Mental Health Research
    Date: 03/2010
    This study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in payment sources vary for the seriously mentally ill relative to all other mental health conditions.
  • Availability and Use of Health Plan Choices in Rural America: Medicare+Choice, Commercial HMO, and Federal Employees Health Benefit Program Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2003
    This report discusses the availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program insurance plans and the potential impact of M+C service delivery area changes on healthcare access in rural areas.
  • Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas
    Fact Sheet
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2014
    Research suggests enrollment rates for those in rural areas was less than urban areas during the first Health Insurance Marketplace enrollment period. Interviews of navigators, health centers, and others in rural counties with high enrollment rates were conducted to uncover best practices for marketing, outreach/education, in-reach, and enrollment.
  • Changing Rural and Urban Enrollment in State Medicaid Programs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-Affordable Care Act (ACA). Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas.
  • Diabetes and the Rural Safety Net
    Maine Rural Health Research Center
    Date: 01/2002
    This paper investigates the extent to which the rural safety net is able to meet the needs of people with diabetes.
  • Distance and Networks: A Regional Analysis of Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2018
    Using 2015-16 data on 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in insurance issuer participation, premiums, and enrollment success through its effect on network adequacy and assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.
  • Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2016
    Views on how the implementation of the Affordable Care Act's (ACA) expanded insurance coverage is affecting the financial performance of rural hospitals. The study found that while respondents believe the expanded insurance coverage was the right thing to do for patients, they worried coverage may not be adequate to ensure access to care.
  • Effects of the Patient Protection and Affordable Care Act on Coverage and Access to Care in Metropolitan vs. Nonmetropolitan Areas Through 2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2019
    The Patient Protection and Affordable Care Act as a whole led to notable increases in coverage rate and better access to care in both metropolitan and nonmetropolitan areas, and the Medicaid expansion was the key driver of coverage gains in nonmetropolitan areas.
  • Enrollment in FEHBP Plans in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    This study of health plan enrollment decisions made by rural retirees and federal workers examines how a Federal Employees Health Benefit Program plan may work when applied to Medicare.
  • Enrollment in the Federal Employees Health Benefit Program (FEHBP): State and County-Level Enrollment Analysis
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    This analysis details information on Federal Employees Health Benefit Program (FEHBP) enrollment in rural counties, including the number of health insurance plans available and number of enrollees. FEHBP is being considered as a model for involving private insurers in Medicare.
  • Factors Associated With Lengths-of-Stay for Inpatients With Substance Use Disorders
    Policy Brief
    Rural Health Equity Research Center
    Date: 04/2023
    This policy brief identifies factors associated with inpatient length-of-stay (LOS) for the treatment of substance use disorders (SUDs), and whether there are systematic differences in LOS for rural and urban residents.
  • The Federal Employees Health Benefits Program: A Model for Competition in Rural America?
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 2005
    Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas.
  • Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2014
    This brief combines the data on plan selection in the federally facilitated marketplaces with estimates of those likely to qualify for the marketplace to calculate the percentage of potential eligible individuals who chose a health insurance plan (the uptake rate). It contains a heat map showing the variation in uptake rates across the country.
  • Geographic Variation in Premiums in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2014
    This policy brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act.
  • A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2014
    This brief provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces across geography.
  • Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
    Policy Brief
    Maine Rural Health Research Center
    Date: 10/2016
    We describe regional distribution and market prevalence of Consumer Operated and Oriented Plan (CO-OP) products in rural and urban counties, and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015.
  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    Analysis of national county-level Health Insurance Marketplace (HIM) plan data for 2014 and 2015 shows there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.
  • Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2018
    This brief assesses changes from 2014 to 2018 in average Health Insurance Marketplace plan participation and pre-subsidy premiums in rural and urban places. Insurance carriers reduced participation across both, while the gap between average premiums in expansion and non-expansion states is widening at a similar rate in rural and urban counties.
  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
  • High Deductible Health Insurance Plans in Rural Areas
    Maine Rural Health Research Center
    Date: 05/2014
    Using the 2007-2010 National Health Interview Survey, this study examines rural residents' enrollment in high deductible health plans and the implications for evolving Affordable Care Act Health Insurance Marketplaces.
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    Maine Rural Health Research Center
    Date: 10/2010
    This study explores the impact of changes in employment status on insurance coverage for rural and urban workers.
  • An Insurance Profile of Rural America: Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2022
    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 describes these trends in detail.
  • Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
    Policy Brief
    Maine Rural Health Research Center
    Date: 07/2017
    Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services. This study examined rural-urban differences in knowledge and/or use of the Affordable Care Act Marketplaces; subsidies; the health insurance mandate; and health insurance terms and concepts.
  • The Market Mechanism and Health Insurance in Rural Places: Lessons Learned From an Economics and Policy Perspective
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2019
    This paper focuses on unique challenges in health insurance markets facing rural people, providers, and places, identifying their origins in what economists call "market failures," defined narrowly or broadly. We conclude with observations about the current landscape of rural insurance markets and identify issues policy makers should consider.
  • Nonmetropolitan Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces in 2022
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2024
    This policy brief describes differences in unsubsidized and net-of-subsidy premiums between nonmetropolitan and metropolitan counties in Health Insurance Marketplace plan design and availability in 2022.
  • The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2010
    This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
  • Premium Assistance Programs for Low Income Families: How Well Does It Work in Rural Areas?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2006
    This paper reports the results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals.
  • Private Health Insurance in Rural Areas: Challenges and Opportunities
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2009
    This brief discusses the challenges of expanding private coverage in rural areas and describes policy options to address them.
  • Recent Changes in Health Insurance Coverage in Rural and Urban Areas
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2011
    This findings brief compares changes in health insurance coverage for non-elderly Americans in rural areas to changes in urban areas during the recent economic recession.
  • Regulating Network Adequacy for Rural Populations: Perspectives of Five States
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2017
    The purpose of this study was to examine how five geographically-diverse states with significant rural populations define "network adequacy" and the degree to which they consider rural issues when regulating networks.
  • The Role of Public Versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2017
    Medicaid and CHIP have played a critical role in ensuring access to health coverage among children –particularly rural children. This study examines rural-urban differences in children's access to care, and their families' perceived affordability of that care among those enrolled in Medicaid or CHIP, and those with private insurance plans.
  • Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study provides detailed information about rural-urban differences among adults younger than age 65 in perceived affordability of health insurance coverage and services prior to implementation of the Affordable Care Act.
  • Rural Coverage Gaps Decline Following Public Health Insurance Expansions
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2009
    This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural/urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss characteristics of the rural uninsured and the implications for health insurance reform.
  • Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    Most beneficiaries seek added coverage to close the gap between the care they need and the costs covered by Medicare. This study evaluated rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015
    This brief analyzes Health Insurance Marketplace enrollment outcomes for 2015 at rating area/county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, census region, and metropolitan status of the county. Rural/urban rates are often similar, but areas of concern exist.
  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015
    This brief compares cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas by state and the percentages of potential market participants enrolled. Non-metropolitan enrollment rates were higher in several states. The analysis shows how well outreach/enrollment efforts targeting rural areas work.
  • Rural Enrollment in the Federally Facilitated Marketplace
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 06/2016
    Analyzes the differences in rural and urban enrollment rates in counties across 32 states by using data from the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services.
  • Rural Health Snapshot (2017)
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 05/2017
    The Rural Health Snapshot (2017) updates the 2010 Rural Health Snapshot. The document is a data sheet that compares a selection of health and healthcare access indicators for populations in rural and urban areas.
  • Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2014
    This report presents various states' approaches to the Health Insurance Marketplace, including service and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.
  • Rural Provider Perceptions of the ACA: Case Studies in Four States
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2015
    This brief summarizes the perceptions from rural providers in four states regarding the early effects of the Affordable Care Act, including changes to patient populations, financial health, and capacity for rural hospitals and rural federally qualified health centers.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2015
    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
  • Rural-Urban Differences in Insurer Participation for Marketplace-Based Coverage
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2016
    This policy brief examines the differences between rural and urban counties in terms of the number and composition of insurers in Federally-Facilitated Marketplaces.
  • Rural/Urban Analysis on Individual Insurance Market Topics
    Fact Sheet
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers.
  • Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2010
    The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
  • State Health Insurance Exchanges: Assessing Rural Implications of Statutes
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2013
    This report analyzes how five characteristics of health insurance exchanges might address particular rural concerns.
  • Successful Health Insurance Outreach, Education, and Enrollment Strategies for Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief offers best practices for hospitals to use in health insurance outreach/enrollment based on interviews with administrators, staff, and community reps at 11 rural hospitals. It also discusses certified application counselors and the importance of collaborative community partnerships in conducting insurance enrollment outreach/education.
  • Update: Health Insurance and Utilization of Care Among Rural Adolescents
    Journal Article
    Rural and Minority Health Research Center
    Date: 2005
    Using data from the 1999-2000 National Health Interview Survey, it was found that across races, rural adolescents were as likely to have insurance but less likely to report a preventive visit than urban children; residence did not affect the likelihood of a visit or a usual source of care.