This project focuses on rural-urban differences in access to, and enrollment in, Medicare Advantage (MA) plans with four- and five-star quality ratings. The results will include comparisons across geography and across types of MA plans [Health Maintenance Organization (HMO), HMO vs Preferred Provider Organization (PPO), PPOs, or other types].

Data for this analysis are drawn primarily from the Centers for Medicare and Medicaid Services (CMS) website, including plan offerings by county, characteristics of those plans, star ratings of the plans, and enrollment in the plans, supplemented by additional sources as needed. The project will analyze:

1. The percent of plans offered in each county that are 4- or 5-star rated, including zero percent if there are none. Researchers will use that number to compare across the three geographic categories.
2. The percentages of rural and urban HMO and PPO enrollment by MA plan star rating.
3. Differences in race/ethnicity across counties in different levels of plan offerings, and in plan offerings from MA plans with 4- or 5-star ratings.
4. The quality by quintile of rural enrollment, i.e. rank all the plans (or contracts) by percent rural enrollment, then calculate enrollment-weighted stars within each quintile, and explore potential drivers of differences, including which star domains were lower that drove an overall lower value.