Document Type

Policy Brief

Publication Date



Access/Insurance, Rural, Medicare, out-of-pocket, beneficiaries, variation, spending, MRHRC, USM Aging Initiative, Health and Wellness


The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey to evaluate rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service. The proportion of total spending paid out-of-pocket is 40% higher among rural disabled Medicare beneficiaries compared to urban disabled beneficiaries. Rural disabled and elderly beneficiaries are more likely to go without any form of supplemental coverage than urban beneficiaries.

Funding Organization

Federal Office of Rural Health Policy

Grant Number




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.