The main goal of this study is to examine the relationship among residence (rural/nonmetropolitan/urban), individual traits of elders, community characteristics, and realized access to health care. For this research access to care, referred to as realized access, is defined as (1) reporting trouble getting care (2) physician visits, and (3) prescription drug utilization. The aims of this research are to: (1) Determine if changes in realized access to care have occurred over a 5 year period from 1999-2004. (2) Determine whether, rural residence’s influence on realized access to care persists when individual traits of elders (insurance, age, education, income, race, health, and health beliefs) and community traits (physician supply, percentage of the population aged 65 and older, and transportation issues) are considered. Data for this study are derived from the Medicare Current Beneficiary Survey (MCBS) and the Area Resource File. The sample consists of individuals within the MCBS who are living in the community and are aged 65 and over. Multiple OLS regression and logistic regression with difference in difference estimators are used to address the aims. Results indicate a decreased number of elders reporting trouble getting care over the five year period and an increase in both physician visits and prescription drug use. Rural elders are found to use fewer physicians as compared to urban elders, but no difference is found in the use of prescription drugs, or trouble getting care in relation to residence when controlling for individual and community traits. Only one of the community characteristics (percentage of the population aged 65+) is found to be related to realized access. This research adds to the literature focusing on rural access and the need for clear definitions of residence and the need for further research to understand the complex relationships between residence, community, and individual with realized access.