Enrollment in Medicare Advantage (MA) plans has consistently increased since the program's redesignation by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. MA plans have long included supplemental benefits not available in original Medicare, such as dental and vision coverage. Additional supplemental benefits are becoming available through MA plans, such as those serving beneficiaries with chronic conditions. Yet in 2019, a considerable gap remained between rural and urban MA enrollment. Given these gaps in plan availability, rural beneficiaries may also lack access to plans offering supplemental benefits not covered in original Medicare. This brief identifies differences in MA plans that include supplemental benefits available to rural (nonmetropolitan) and urban (metropolitan) enrollees.

We find that beneficiaries in noncore and micropolitan counties have significantly fewer MA plans to choose from, with most of the difference attributable to lower availability of health maintenance organization and local preferred provider organization plans. Among the 13 most common MA supplemental benefits, 11 are available in fewer nonmetropolitan counties compared to metropolitan counties. The difference in supplemental benefits is most prominent for hearing exams, eye exams, preventive dental care, fitness programs, remote access technologies, health education, and over-the-counter items.