Since 1997, Medicare beneficiaries have been able to enroll in Medicare+Choice (M+C), which allows them to choose a health maintenance organization (HMO), preferred provider organization (PPO), or other options besides the traditional fee-for-service Medicare, which does not offer prescription drug coverage. Although enrollment in M+C by Medicare beneficiaries has increased considerably in recent years, it remains quite low in rural areas, according to a study supported by the Agency for Healthcare Research and Quality (HS10183) and led by Keith J. Mueller, Ph.D., of the University of Nebraska Medical Center. Dr. Mueller and his colleagues calculated M+C enrollment in rural counties from September 1997 to September 2001, and M+C plan entry and exit through January 2002.
From September 1997 to September 2001, total rural M+C enrollment dropped from 173,359 beneficiaries (1.9 percent) to 150,648 (1.6 percent), a considerable decrease from the 2.1 percent enrolled in October 2000. Urban M+C enrollment grew from 4,836,100 (16.5 percent) in September 1997 to 5,410,409 (17.7 percent) in September 2001. M+C enrollment in all rural counties has fallen since 1999, a trend that reflects, in part, the exit of M+C plans that occurred in 1999 and 2000.
Of the 179 M+C plans in existence in 2001, 110 plans had rural enrollees; 72 plans had 100 or more rural enrollees; and only 40 plans had 1,000 or more rural enrollees. Also, by September 2001, rural M+C enrollment exceeded 1,000 beneficiaries in only 22 States, and 10 States had no rural M+C enrollees. M+C plan exits disproportionately affected rural beneficiaries, with many who lost their plan having no access to other M+C plans. Although only 3.7 percent of M+C enrollees lived in rural areas, 14 percent of rural enrollees were affected by exits in 1999, 12 percent in 2000, and 7 percent in 2001. Only 3.5 percent of M+C enrollees in rural areas were affected by plan exit in 2002.
More details are in "An update on Medicare+Choice: Rural Medicare beneficiaries enrolled in Medicare+Choice plans through September 2001," by Timothy D. McBride, Ph.D., Courtney Andrews, Alexei Makarkin, and Dr. Mueller, in the August 2002 Rural Policy Brief 7(4), pp. 1-8.