In addition, the oldest rural seniors are particularly likely to lack prescription drug coverage. Over half of rural seniors age 85 or older have no drug coverage, more than 50 percent higher than urban seniors that age. 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. They would not qualify for direct premium assistance in plans that subsidize low income beneficiaries but do not have enough income to afford private insurance.
Rural beneficiaries are about one-third less likely to have retiree health insurance.
Only about one in four of rural seniors have drug coverage through employer-based retiree insurance, compared to 35 percent of urban seniors. 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. About 13 percent of rural Medicare beneficiaries receive prescription drug coverage through Medigap compared to 11 percent of urban beneficiaries.