Rural residents paid higher premiums and had fewer options on the Patient Protection and Affordable Care Act exchanges in 2014 than their urban counterparts, according to new analysis.

The average monthly premium for a silver plan, the second-cheapest exchange plan designed to cover 70 percent of medical costs, was $387 in rural counties, while city dwellers pay $369 for the same kind of plan, according to research from the Robert Wood Johnson Foundation and the University of Pennsylvania. But in some states the gap grew much wider.

In Nevada, for example, residents of rural counties spend, on average, $554 a month for a silver plan. That's 57 percent more than their city peers.

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