Current U.S. policy utilizes various market-based models within Medicare, Medicaid, and Health Insurance Marketplaces to ensure access to health insurance coverage, but access is increasingly uneven and unaffordable, especially in some rural areas. After giving an overview of some of the relevant economic theory, illustrated with examples across all of the major programs, this brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.