The Rural Price Tag
Published February 2026 · 14 min read
The Urban-Rural Divide
Urban areas account for 91% of all Medicare spending with 7.6x more providers — but per-service costs are 18% higher.
Two Americas of Healthcare
Medicare data reveals a stark geographic divide in American healthcare. Urban areas have more providers, more services, more specialties, and higher per-service prices. Rural areas have fewer options, lower prices, but also less access to specialists and advanced procedures.
The Access Gap
While rural Medicare beneficiaries pay less per service on average, they also have fewer services available to them. Specialties like radiation oncology, interventional cardiology, and advanced surgical specialties are overwhelmingly concentrated in urban areas. This means rural patients often travel hours for specialized care — a hidden cost that doesn't show up in payment data.
The Price Premium
Urban providers command higher per-service payments across virtually every specialty. This reflects higher cost of living, more expensive facilities, and the market power of large urban health systems. But it also raises questions about whether Medicare's geographic payment adjustments are calibrated correctly.