Cities Offer Widest Selection of Medicare HMOs.

Medicare beneficiaries living in urban areas are more likely than those living in rural areas to have a choice of Medicare-risk health maintenance organizations, according to a study by Mathematica Policy Research Inc.

Only 2% of beneficiaries living in the core counties of large urban areas and 25% of those in other surrounding counties don't have access to at least one Medicare+Choice plan, the study found. In contrast, 64% of beneficiaries in rural counties next to metropolitan areas and 91% of those in nonadjacent rural counties lack the option of joining a Medicare+Choice plan, according to the study.

About 10% of all enrollees in 1999 and 25% in 2000 had no Medicare+Choice plan available in their area.

The study looked at the availability of Medicare+ Choice plans as companies are dropping coverage in areas where they say reimbursement rates are too low. In 1999,43 Medicare-risk HMOs left and 52 reduced service areas, dropping about 400,000 beneficiaries. In July, the Health Care Financing Administration said that Medicare-risk HMOs would drop 327,000 people, or 5% of all enrollees, in 2000.

While some companies are leaving, 35 new plans will enter the program or expand their service areas, according to HCFA.