This lack of coverage is even more dramatic when looking those who are uninsured for part of the year. About 57 percent of rural Medicare beneficiaries do not have prescription drug coverage for all or part of the year, compared to 44 percent of urban beneficiaries. In addition, the oldest rural seniors are particularly likely to lack prescription drug coverage. In rural America, most beneficiaries who lack prescription drug coverage are middle income. Although rural seniors have lower incomes than urban seniors, about 45 percent of those without prescription drug coverage have incomes between 150 and 400 percent of poverty.
Rural beneficiaries are about one-third less likely to have retiree health insurance.
Less than 1 percent of rural beneficiaries are enrolled in Medicare managed care with a prescription drug benefit. About 75 percent of rural beneficiaries do not have a managed care option, and no state has more than 30 percent of rural beneficiaries enrolled in managed care. Due to lack of alternatives and the critical need for drug coverage, rural seniors disproportionately purchase Medigap. Premiums for Medigap for rural beneficiaries are high and increase with age. He will raise concerns about the Republican proposal that would use a flawed Medigap-like model that would not work for all Medicare beneficiaries.