Concerns about access to home healthcare for rural beneficiaries persist despite historical and current incentive payments for home health agencies to provide care in rural communities. Medicare administrative data for rural Medicare beneficiaries in 2013 was combined with publicly available data on healthcare utilization from the Centers for Medicare and Medicaid Services for a county-level analysis of home healthcare use by rural-urban status and geographic region. The percent of beneficiaries using home health was significantly lower in the most remote rural counties compared to urban counties. Significant geographic variation in use of home health was also present and appears to be a larger driver of variation in use of home health than urban-rural status. Findings support targeting of incentive payments for home health agencies serving the most rural communities and rural communities with low utilization.