Rural Spotlight

December 11, 2025

Rural Health Research Alert: Rural-Urban Differences in Barriers to Care and Utilization of Preventive Care Among Traditional Medicare and Medicare Advantage Beneficiaries

This policy brief examined rural and urban differences in barriers to care and use of preventive care services among enrollees in traditional Medicare and Medicare Advantage. Medicare Current Beneficiary Survey data was used to examine barriers to care, such as flu shots and cholesterol tests, comparing rural and urban Medicare Advantage enrollees, rural and urban traditional Medicare enrollees, and rural traditional and Medicare Advantage enrollees.

Key Findings:

• Rural Medicare Advantage enrollees faced more barriers in accessing health services due to cost, compared to their urban counterparts and to all traditional Medicare enrollees, urban and rural.
• A lower proportion of rural enrollees in both traditional Medicare and Medicare Advantage received a flu shot compared to their urban counterparts.
• Female traditional Medicare enrollees living in rural areas were the least likely to utilize health care services compared to both their urban counterparts and Medicare Advantage enrollees.

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December 11, 2025

Rural Health Research Alert: Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022

Infant mortality is elevated in rural, compared with urban, communities. Neonatal health care includes basic well-infant/level 1 services, available at health care facilities that offer childbirth services, as well as higher-level care (neonatal intermediate and intensive care services, at level II or higher).

Access to higher-level neonatal care can be lifesaving for infants with high acuity clinical needs, and access to childbirth-related care has been declining in rural communities.

The purpose of this policy brief is to show the changes in the availability of higher-level neonatal care in rural United States (U.S.) counties from 2010 to 2022, and how this availability differs by rural county type (micropolitan vs. noncore).

Key Findings:

• Researchers examined availability of higher-level neonatal care (intermediate level II or intensive level III or IV care) at short-term acute care hospitals in rural counties of the U.S., including all hospitals not involved in mergers between 2010 and 2022.

• In the U.S., availability of any higher-level neonatal care declined from 2010-2022 in rural counties. Overall, 7.5% of rural counties (147/1958) had higher-level neonatal care in 2010, and 6.9% of rural counties (136/1958) had this care in 2022. In 2022, 93.1% of rural counties (1822/1958) had no higher-level neonatal care.
• Among rural counties, researchers distinguished between noncore and micropolitan counties. Among noncore counties, the percentage with higher-level neonatal care declined from 2.1% (27/1300) in 2010 to 1.2% (16/1300) in 2022. In 2010, 18.2% of micropolitan counties (120/658) had higher-level neonatal care, remaining similar in 2022 (18.2%; 120/658).
• Only about 1% of noncore rural counties had higher-level neonatal care availability in 2022; 20 of the 27 noncore counties that had higher-level neonatal care in 2010 lost this service by 2022.

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