Medicare Advantage Enrollment Update

Medicare Advantage Enrollment Update 2020

The 2020 edition of the RUPRI Center’s annual report on Medicare Advantage (MA) enrollment shows that as of March 2020, 36.1% of eligible Medicare beneficiaries were in an MA plan. The proportion of metropolitan enrollment (38.0%) is higher than that in nonmetropolitan counties (27.5%), but the rate of growth in enrollment has been higher in nonmetropolitan counties for the last three years.

Metropolitan MA enrollment in Health Maintenance Organization (HMO) plans remains strong (64.3% in 2020) but has declined since 2016 and is at its lowest level since at least 2009. The plurality of nonmetropolitan MA enrollment has been in local Preferred Provider Organization plans since 2012 (46.6% in 2020), but the percentage of nonmetropolitan enrollees in HMO plans has grown nearly every year since at least 2009. Enrollment in Private Fee-For-Service plans has continued to slide, reaching its lowest levels for both metropolitan and nonmetropolitan enrollees since at least 2009 (0.2% metropolitan and 1.2% nonmetropolitan in 2020).

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Rapid Response to Requests for Rural Data Analysis
Phone: 319.384.3832

Trends in Preterm Births by Rural Status in the U.S., 2012-2018

April 27, 2021

Click here to view the Study

Trends in Singleton Preterm Birth by Rural Status in the U.S., 2012-2018

Rates of infant mortality and preterm birth in the U.S. are among the highest of any industrialized nation and significant disparities in rates exist by maternal characteristics. This study examines singleton* preterm birth rates from 2012-2018 by rurality and census region using birth certificate data from the National Center for Health Statistics.

The data showed preterm singleton birth rates were consistently higher in rural versus urban areas across all race and ethnic groups, payment sources for delivery, and persons participating in the Women, Infants, and Children program. The increased risk for infant and maternal mortality and morbidity in rural areas highlights the importance of health assistance programs for pregnant women, mothers, and children in these rural communities.

*A singleton birth is the birth of only one child during a single delivery with a gestation of 20 weeks or more.

Contact Information:

Maria Perez-Patron, PhD
Southwest Rural Health Research Center
Phone: 979.436.9490

Rural Health Research

The University of Minnesota Rural Health Research Center released a policy brief and infographic illustrating the differences between urban and rural hospitals that provide obstetric services by their size, capacity, location, and community characteristics, as well as comparing these factors between rural hospitals with obstetric services and those that recently closed their obstetric units.

Contact Information:

Julia Interrante, MPH
University of Minnesota Rural Health Research Center
Phone: 612.626.8401

Webinar: HIV and Hepatitis C in Rural Areas: Prevalence, Service Availability, and Challenges

Date: Wednesday, April 21, 2021
Time: 10:00 AM Pacific, 11:00 AM Mountain, 12:00 PM Central, 1:00 PM Eastern
Zoom Link:

Speakers will highlight findings from recent work on estimating HIV prevalence and maternal hepatitis C prevalence in rural areas across the U.S. Speakers will also discuss findings from a qualitative study on the challenges and promising practices in addressing HIV and hepatitis C outbreaks in rural areas. Presenters for this webinar include Katherine Ahrens and Amanda Burgess from the Maine Rural Health Research Center.

Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies

Post-acute care services are designed to help patients transition from hospitalization in acute care facilities to their homes. Skilled nursing facilities and home health agencies provide the majority of post-acute care services to Medicare beneficiaries. This study used Medicare administrative data for rural, fee-for-service Medicare beneficiaries to describe post-acute care trajectories following acute hospitalization and examine differences between planned discharge disposition from the hospital and actual post-acute care received.

The majority (56.3%) of rural beneficiaries did not receive post-acute care following hospital discharge, while about a quarter (26.1%) experienced at least one care transition. Transition to skilled nursing facility (23.7%), transition to home health agency (18.2%), and transition to a skilled nursing facility followed by an additional transition to a home health agency (6.9%) were the most common trajectories among rural beneficiaries who received post-acute care. Gaps exist between planned and actual receipt of post-acute care as 88.9% of rural beneficiaries who had a planned discharged to a skilled nursing facility received this care and 58.7% of rural beneficiaries who had a planned discharge to a home health agency received this care. Identification of the reasons for the gaps between planned versus actual discharge to post-acute care and the outcomes for those who did not receive planned care will be critical for determining appropriate supports to improve care transitions for rural beneficiaries.

The full study is available here.

Contact Information:

Tracy Mroz, PhD
WWAMI Rural Health Research Center
Phone: 206.598.5396

Geographic Expansion of Medicaid Managed Care Organizations

As states have increasingly contracted with managed care organizations (MCOs) to serve their Medicaid populations, many of the counties newly served by Medicaid MCOs within the last decade have been nonmetropolitan counties. This brief assesses access to primary care in nonmetropolitan counties for Medicaid recipients in 15 states that expanded Medicaid MCOs to new geographic areas across the state from 2012-2018.

Researchers calculated and analyzed a “primary care provider (PCP) access score” (summarizing actual driving times to the nearest primary care) using geospatial methods and assessed the relationship between stronger state policies on network adequacy to observed PCP access scores in nonmetropolitan settings. The study found that nonmetropolitan counties that had Medicaid MCOs prior to 2012 experienced better access to primary care than nonmetropolitan counties that expanded to Medicaid MCO coverage after 2012, and that nonmetropolitan counties in states that specify stronger network adequacy travel time requirements for PCPs had better PCP access scores on average than those in states that allow longer travel times. Additionally, researchers estimate that among nonmetropolitan counties that were newly served by Medicaid MCOs in 2012-2018, a segment of roughly 45,000 Medicaid recipients experienced relatively low PCP access scores and thus less access to primary care.

Contact Information:

Timothy D. McBride, MS, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 314.935.4356

Additional Resources of Interest:

New Articles Published on Inpatient Volume, Long-Term Care Planning, Emergency Department Telemedicine, Cancer, and Hepatitis C

These journal articles written by the Rural Health Research Centers were recently added to Gateway.

Gateway lists the journal, a brief summary, and a link to additional information and access to the full text of the article, if available. While some journal articles are freely available, many require a subscription or affiliation with a subscribing library.