The University of Iowa’s RUPRI Center for Rural Health Policy Analysis has released a new rural policy brief, “2012 Rural Medicare Advantage Quality Ratings and Bonus Payments”. The Patient Protection and Affordable Care Act of 2010 established bonus payments to reward Medicare Advantage (MA) plans with high quality ratings (4 stars or higher) beginning in 2012. In addition, the Centers for Medicare and Medicaid Services created a demonstration project that expanded the quality-based bonus payments to plans with lower quality ratings (3 stars or higher) from 2012 through 2014. This brief analyzes differences in quality and payment and suggests reasons why quality ratings vary by geography.