["The Journal of Rural Health, Volume 42, Issue 2, Spring 2026. ", "\nAbstract\n\nPurpose\nRural older adults with chronic disease face greater health care access and quality barriers than non‐rural older adults which may result in poorer health‐related quality of life (HRQoL). Few studies have explored if rural health disparities are related to geographic mobility, specifically, how long an individual has lived in a particular area. This study explored the relationship between residence tenure (aging‐in‐place vs. in‐migrants), HRQoL and preference for health care decision‐making among a nationally representative sample of Medicare beneficiaries living with a chronic disease.\n\n\nMethods\nUsing National Health and Aging Trends (NHATS) data, we examined 1012 older Medicare beneficiaries living with a chronic disease who participated in a supplemental chronic disease self‐management (CDSM) module.\n\n\nFindings\nOf the rural residents (n = 218) in the sample, 76% were aging‐in‐place (n = 166) and 24% were in‐migrants (n = 52). Aging‐in‐place older adults reported lower self‐rated health (M = 3.12, p < 0.05) than in‐migrants (M = 3.31) and non‐rural residents (M = 3.35) and reported higher anxiety (M = 0.99, p < 0.05) than in‐migrants (M = 0.54) and non‐rural residents (M = 0.73).\n\n\nConclusions\nResults showed that rural older adults were not more likely to prefer independent health care decision‐making, contrasting some previous studies. Implications of this research point to needed improvements in delivering person‐centered care in clinical settings and in Medicare mental health coverage. The role of residence tenure in health outcomes is an important topic for ongoing examination.\n\n"]