Elderly individuals age 65 and over constitute the majority of the Medicare population. Among Medicare beneficiaries, healthcare access problems are greater among individuals with low incomes, in poor health, and with four or more chronic conditions. These and other barriers may lead to rural-urban differences in health care use among the elderly. This study uses the 2011-2013 Medicare Current Beneficiary Survey to compare health access and use of health services among fee-for-service Medicare beneficiaries age 65 and over in rural versus urban settings, and the factors associated with rural access problems. Findings from this study will help policymakers understand the needs of the growing elderly population and how best to adjust Medicare benefit design and service delivery to reduce barriers to care.