Document Type

Policy Brief

Publication Date



rural, older adults, Medicare, health care, access, utlization


The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

  1. socioeconomic and health characteristics that may inform health care use;
  2. trends in health care use, including use of inpatient and emergency department (ED) care; outpatient and prescription services; specialists and dentists; and home health and durable medical equipment.

Although the percentage of older adults (age 65+) remains higher in rural areas of the U.S., we found that adults over age 85 comprise a similar proportion of the Medicare population in rural and urban areas. Findings showed that rural and urban beneficiaries age 85+ had similar health (general health, chronic conditions) and functional outcomes (ADLs, and IADLs) across the study years and that the average number of visits to primary care providers for both rural and urban beneficiaries decreased over time. However, compared with urban beneficiaries, rural beneficiaries were significantly less likely to visit specialists, dentists, and receive outpatient services. Rural-urban differences in the percentage of beneficiaries who visited the Emergency Department were higher in all study years, with significant differences in 2011, 2012, and 2017.

FMI: Yvonne Jonk, PhD, Deputy Director, Maine Rural Health Research Center.


This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement #U1CRH03716. The information, conclusions and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Organization

Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services

Grant Number




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