Access to timely, appropriate, and affordable healthcare is important for health outcomes and overall well-being. Access to care is partially determined by access to insurance coverage to help make such care affordable and attainable. Because Medicare provides nearly-universal insurance coverage for older adults in the U.S., as well as for some non-elderly adults with disabilities, access to care should in theory be guaranteed for individuals with Medicare coverage. However, there is ample evidence showing that some Medicare beneficiaries—including rural residents—still struggle to access care when they need it. Rural Medicare beneficiaries face particular hurdles in accessing care, including longer distances to healthcare facilities, lower median incomes, fewer supplemental Medigap and Medicare Advantage plan options, higher disability rates (leading to greater need), and healthcare workforce shortages.

Given these differences, current information is needed about access to care for rural Medicare beneficiaries in order to inform policies and programs to ensure the best possible healthcare access and health outcomes. National in scope this project has relevance for policy making and healthcare delivery at the federal, regional, state, and local levels.

The sample included Medicare beneficiaries from across the country and was weighted to generate nationally-representative estimates. Key informants were selected from each of the four census regions to ensure national coverage. We analyzed rural-urban differences in multiple dimensions of access to care, including use of routine and preventive care, as well as difficulty getting necessary care due to concerns about cost, coverage type, inability to find a provider, difficulty with transportation, and difficulty with scheduling; analyzed within-rural differences in multiple dimensions of access to care by coverage type, rurality, region, health status, and socio-demographic characteristics; described the experiences of rural safety net providers in helping to provide access to care for Medicare beneficiaries; and identified policy and programmatic interventions to improve access to care for rural Medicare beneficiaries. In primary data collection, we asked key informants about their experiences providing safety net care to rural Medicare beneficiaries, including their perceptions the most challenging aspects of accessing care. We also asked them about potential policy and programmatic interventions. We coded the interviews to identify themes and policy implications.

Publications

• Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
• Access to Specialty Care for Medicare Beneficiaries in Rural Communities
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
• Barriers to Health Care Access for Rural Medicare Beneficiaries: Recommendations From Rural Health Clinics
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 01/2021
  This brief presents findings from an online survey of Rural Health Clinics describing barriers for Medicare patients in accessing healthcare services and recommendations for how to improve access to care for Medicare beneficiaries in rural areas.
• Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 02/2022
  This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
• Differences by Rurality in Satisfaction With Care Among Medicare Beneficiaries
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 05/2020
  There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
• Measuring Access to Care in National Surveys: Implications for Rural Health
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 06/2019
  This brief presents data about how access to healthcare is measured, focusing on how this applies to rural populations.
• Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.