Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts

OVERVIEW Medicare provides near-universal coverage for seniors and is an important source of health insurance for individuals with disabilities; however, many beneficiaries face gaps between the care they need and costs covered by Medicare. Most beneficiaries either participate in Medicare Advantage (a managed care version of Medicare that offers reduced cost-sharing) or seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. These options have different cost-sharing arrangements, with Medicaid, employer-based plans, and Medicare Advantage plans offering the greatest protection against high outof-pocket spending.1 However, despite high rates of supplemental coverage, median out-of-pocket spending as a percent of income among Medicare beneficiaries was 17% in 2007.2 Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether,3 it is likely that their out-ofpocket spending differs from those of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries.