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Medicare: An Overview
This document contains 22 figures that provide data on key characteristics of the Medicare population and program in the United States. Some of the key facts presented include: - In 2010, 55% of Medicare beneficiaries were female, 77% were white, and 44% were between ages 65-74. Chronic conditions, functional impairments, and cognitive issues were common. - Spending on healthcare makes up a larger share of household budgets for Medicare beneficiaries compared to non-beneficiaries. Out-of-pocket spending includes significant costs for premiums, drugs, and long-term care. - Medicare Advantage enrollment has grown substantially in recent decades and now covers 30% of beneficiaries nationally. Supplemental coverage comes from a variety
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Medicare: An Overview
- 1. Figure 1 Gender Race/EthnicityAge SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Selected Demographic Characteristics of Medicare Beneficiaries, 2010 Male 45% Female 55% White 77% Black 10% Hispanic 9% 75-84 27% <65 16% 65-74 44% 85+ 13% Other 5%
- 2. Figure 2 45% 34% 31% 26% NOTE: ADLis activity of daily living. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Selected Measures of Health Status of the Medicare Population, 2010 Percent of all Medicare beneficiaries: 4+ Chronic Conditions Functional Impairment (1+ ADL Limitations) Cognitive/Mental Impairment Fair/Poor Health
- 3. Figure 3 25%: incomesbelow $14,400 50%: incomes below $23,500 5%: incomes above $93,900 NOTE: Total household income for couples is split equally between husbands and wives to estimate income for married beneficiaries. SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation. Distribution of Medicare Beneficiaries By Income, 2013
- 4. Figure 4 Percent ofTraditional Medicare population with: 3% 5% 9% 19% 78% 89% NOTE: Analysis excludes beneficiaries enrolled in Medicare Advantage. SOURCES: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Medicare Beneficiaries’ Utilization of Selected Medicare- Covered Services, 2010 Prescription drug use Physician office visit Inpatient hospital stay Home health visit Skilled nursing facility stay Hospice days
- 5. Figure 5 Housing $16,976 32.0% $9,660 18.2% $2,772 5.2% Food $7,890 14.9% Other $15,702 29.6% Housing $11,673* 34.3% $5,087* 15.0% HealthCare $4,722* 13.9%* Food $5,189* 15.3%Other $7,321* 21.5%* NOTE: *Estimate statistically significantly different from the non-Medicare household estimate at the 95 percent confidence level. SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense Files, 2012. Distribution of Average Household Spending by Medicare and Non-Medicare Households, 2012 Transportation Transportation Health Care Non-Medicare Household SpendingMedicare Household Spending Average Household Spending, 2012 = $53,000 Average Household Spending, 2012 = $33,993*
- 6. Figure 6 42% $2,000 18% 14% 11% 6% 3% 3% 2%1% 58% $2,746 NOTE: Analysisexcludes beneficiaries enrolled in Medicare Advantage plans. Premiums includes Medicare Parts A and B and other types of health insurance beneficiaries may have (Medigap, employer-sponsored insurance, and other public and private sources). Estimates do not sum to total due to rounding. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Distribution of Average Total Out-of-Pocket Spending on Services and Premiums by Medicare Beneficiaries, 2010 Average Total Out-of-Pocket Spending on Services and Premiums, 2010: $4,745 Long-term care facility Medical providers and supplies Prescription drugs Dental Inpatient hospital Skilled nursing facility Outpatient hospital Home health Premiums Services
- 7. Figure 7 $2,297 $2,274$2,093 $1,537 $1,291 $948 $2,098 $2,402 $2,264 $1,797 $1,858 $2,649 $4,230 $4,246 $2,074 $1,956 $2,845 $6,012 $4,094 $4,131 $4,742 $5,767 $5,537 $3,023 $4,054 $5,247 $8,276 Excellent Very good Good Fair Poor Under 65 65-74 75-84 85+ Services Premiums NOTE: Analysis excludes beneficiaries enrolled in Medicare Advantage plans. Premiums includes Medicare Parts A and B and other types of health insurance beneficiaries may have (Medigap, employer-sponsored insurance, and other public and private sources). SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Medicare Beneficiaries’ Average Total Out-of-Pocket Spending on Services and Premiums, by Self-Reported Health Status and Age, 2010 AgeHealth status
- 8. Figure 8 NOTE: *Amountcorresponds to the estimated catastrophic coverage limit for non-low-income subsidy enrollees ($6,680 for LIS enrollees), which corresponds to True Out-of-Pocket (TrOOP) spending of $4,700 (the amount used to determine when an enrollee reaches the catastrophic coverage threshold. SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit for 2015 (standard benefit parameter update from Centers for Medicare & Medicaid Services, 2014). Amounts rounded to nearest dollar. Standard Medicare Prescription Drug Benefit, 2015 Deductible = $320 Initial Coverage Limit = $2,960 in Total Drug Costs Plan pays 75% Plan pays 15%; Medicare pays 80%Enrollee pays 5% Enrollee pays 25% Catastrophic Coverage Limit = $7,062 in Estimated Total Drug Costs*Brand-name drugs Enrollee pays 45% Plan pays 5% 50% manufacturer discount Generic drugs Enrollee pays 65% Plan pays 35% INITIAL COVERAGE PERIOD COVERAGE GAP (“Doughnut Hole”) CATASTROPHIC COVERAGE DEDUCTIBLE Enrollee pays 100%
- 9. Figure 9 Part Dnon-LIS enrollees 26.6 million 49% Part D LIS enrollees 11.5 million 21% Employer subsidy 2.6 million All other 13.3 million 25% NOTE: LIS is low-income subsidy. Total Part D and Medicare enrollment based on 2014 intermediate estimates. Part D non-LIS enrollment includes enrollees in employer/group waiver plans (6.8 million in 2014). SOURCE: Kaiser Family Foundation analysis of data from the 2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Distribution of Sources of Prescription Drug Coverage Among Medicare Beneficiaries, 2014 Total Medicare Enrollment, 2014 = 54.0 million Total Part D Enrollment (excluding employer plans), 2014 = 38.1 million 5%
- 10. Figure 10 6.9 6.8 6.2 5.65.3 5.3 5.6 6.8 8.4 9.7 10.5 11.1 11.9 13.1 14.4 15.7 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 NOTE: Includes MSAs, cost plans, demonstration plans, and Special Needs Plans as well as other Medicare Advantage plans. SOURCE: MPR/Kaiser Family Foundation analysis of CMS Medicare Advantage enrollment files, 2008-2014, and MPR, “Tracking Medicare Health and Prescription Drug Plans Monthly Report,” 1999-2007; enrollment numbers from March of the respective year, with the exception of 2006, which is from April. Medicare Private Plan Enrollment, 1999-2014 In millions: % of Medicare Beneficiaries 18% 17% 15% 14% 13% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28% 30%
- 11. Figure 11 NOTE: IncludesMSAs, cost plans and demonstrations. Includes Special Needs Plans as well as other Medicare Advantage plans. SOURCE: MPR/Kaiser Family Foundation analysis of CMS State/County Market Penetration Files, 2014. Share of Medicare Beneficiaries Enrolled in Medicare Advantage Plans by State, 2014 National Average, 2014 = 30% < 10% 10% - 19% 20% - 29% 30% - 39% ≥40% (6 states) (12 states + DC) (14 states) (15 states) (3 states) DC 11% 36% 24% 0% 38% 19% 38% 36% 24% 7% 38% 28% 46% 33% 16% 22% 14% 13% 24% 28% 20% 9% 20%51% 13% 26% 17% 13% 33% 6% 15% 30% 35% 28% 14% 38% 16% 43% 39% 22% 15% 32% 29% 34% 7% 15% 29% 24% 35% 30% 3%
- 12. Figure 12 SOURCE: KaiserFamily Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Distribution of Sources of Supplemental Coverage Among Medicare Beneficiaries, 2010 Total Medicare Beneficiaries, 2010 = 48.4 Million 15% 4% 26% 3% 15% 4% 13% 6% 14% Employer-sponsored + Medigap Medicare Advantage + Medicaid Medicare Advantage + Employer-sponsored Other coverage/ combinations No supplemental coverage Medicare Advantage only Medicaid only Medigap only Employer-sponsored only
- 13. Figure 13 66% 46% 36% 40% 40%40% 34% 37% 35% 36% 35% 32% 34% 32% 29% 28% 26% 26% 25% 28% 25% 1988 1991 1993 1995 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 NOTE: Tests found no statistical difference from estimate for the previous year shown (p<.05). No statistical tests are conducted for years prior to 1999. SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2014; KPMG Survey of Employer-Sponsored Health Benefits, 1991, 1993, 1995, 1998; The Health Insurance Association of America (HIAA), 1988. Percent of Large Firms (200+ Workers) Offering Retiree Health Benefits to Active Workers, 1988-2014
- 14. Figure 14 SOURCE: KaiserFamily Foundation analysis of a 5 percent sample of Medicare claims from the Chronic Conditions Data Warehouse, 2010, and Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on FY2010 MSIS. Number of Beneficiaries Enrolled in Medicare, Medicaid, and Both Programs, 2010 Dually eligible 10 million Medicare 40 million Medicaid 56 million Total Medicare beneficiaries, 2010: 50 million Total Medicaid beneficiaries, 2010: 66 million
- 15. Figure 15 80% 66% 86% 66% 20% 34% 14% 34% Dual-eligible beneficiariesNon-dual eligible beneficiaries SOURCE Medicare Payment Advisory Commission and Medicaid and CHIP Payment and Access Commission, Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid (January 2015). Dual-Eligible Beneficiaries as a Share of Medicare and Medicaid Enrollment and Spending, 2010 Total Medicare spending, 2010: $498.9 Billion Total Medicare enrollment, 2010: 48.9 million Total Medicaid spending, 2010: $340.5 billion Total Medicaid enrollment, 2010: 67.2 Million Medicare Medicaid
- 16. Figure 16 2% 11% 22% 25% 63% 17% 39% 48% 56% 70% LTC resident Underage 65 fp health cm impair 3+ Chronic Conditions Dual-eligible Medicare beneficiaries All other Medicare beneficiaries SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Comparison of Characteristics of Dual-Eligible Medicare Beneficiaries and All Other Medicare Beneficiaries Percent of beneficiaries: 3+ chronic conditions Cognitive/mental impairment Fair or poor health Under age 65 Long-term care facility resident
- 17. Figure 17 26% 14% 18% 10% 7% 13% 12% Less than$2,500 $2,500-$5,000 $5,000-$10,000 $10,000-$15,000 $15,000-$20,000 $20,000-$40,000 $40,000 or more SOURCE: Kaiser Family Foundation analysis of a 5 percent sample of Medicare claims from the Chronic Conditions Data Warehouse, 2010. Distribution of Dual-Eligible Medicare Beneficiaries, by Amount of Medicare Spending, 2010 Average Spending, 2010 = $17,745 Median Spending, 2010 = $7,464
- 18. Figure 18 6% 17% 4% 10% 5% 3% 3% 13% <65 65+ <$20,000 $20,000-$39,999 >$40,000 Exc./V. Good/Good Fair/Poor NOTE:Excludes respondents who did not have Medicare eligibility for the full calendar year, such as new enrollees and decedents. Also excludes respondents who did not indicate incomes within specified ranges. All subgroup estimates are statistically significantly different from ‘overall’ estimate. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2012 Access to Care file. Measures of Access to Care Among Medicare Beneficiaries by Demographic Characteristics, 2012 During the past year, percent of beneficiaries reporting that they… Overall Age Income Health Status 11% 28% 8% 18% 11% 5% 7% 22% …delayed getting health care due to cost…had trouble getting needed care
- 19. Figure 19 91% 91% 72%* 71%* 47%* Medicare Private non-capitated Privatecapitated Medicaid Uninsured NOTE: Pediatricians were excluded from Medicare and private non-capitated insurance categories. Physicians who did not respond to relevant survey questions were also excluded. The survey did not ask responding physicians to distinguish Medicare Advantage plans from traditional Medicare or other private insurance. Acceptance rates for patients with insurance status of self-pay or worker’s compensation are not shown. *Indicates difference from Medicare is statistically significant at the 95% confidence level. SOURCE: Kaiser Family Foundation analysis of National Ambulatory Medical Care Survey, National Electronic Health Records Survey, 2012. Percent of Office-Based Physicians Accepting New Patients with Medicare and Other Types of Insurance, 2012
- 20. Figure 20 NOTE: Pediatriciansare excluded from this analysis. Physicians were not asked to distinguish between patients in traditional Medicare and Medicare Advantage plans. SOURCE: Kaiser Family Foundation analysis of National Ambulatory Medical Care Survey, National Electronic Health Records Survey, 2012. Percent of Physicians Accepting New Medicare Patients by State, 2012 DC 83% 79% 87% 80% 86% 94% 89% 82% 91% 97% 98% 93% 84% 88% 94% 92% 93% 90% 94% 86% 81% 84% 92%92% 93% 94% 93% 92% 90% 86% 94% 81% 90% 95% 97% 90% 84% 79% 90% 95% 95% 93% 92% 88% 80% 87% 89% 84% 95% 91% 94% ≤80% 81% - 89% ≥90% (4 states) (16 states, DC) (30 states)
- 21. Figure 21 NOTE: MedicareShared Savings Programs (MSSPs) include 35 Advanced Payment Model participants. Two MSSP participants in Puerto Rico are not displayed on the map. SOURCE: Kaiser Family Foundation analysis of data on ACOs, as of March 4, 2015 from Data.CMS.gov. Accountable Care Organizations (ACOs) in Medicare, 2015 Pioneer ACO participants Medicare Shared Savings Program participants
- 22. Figure 22 NOTES: Nationalreadmission rates include Medicare fee-for-service unplanned hospitalizations for any cause within 30 days of discharge from an initial hospitalization for either heart failure, heart attach, or pneumonia. Rates are risk-adjusted for certain patient characteristics, such as age and other medical conditions. SOURCE: Kaiser Family Foundation analysis of CMS Hospital Compare data files. Medicare Hospital Readmission Rates, 2005-2013 24.5 24.7 24.8 24.7 23.0 22.7 19.9 19.9 19.8 19.7 18.3 17.8 18.2 18.3 18.4 18.5 17.6 17.3 15 16 17 18 19 20 21 22 23 24 25 26 July 2005- June 2008 July 2006- June 2009 July 2007- June 2010 July 2008- June 2011 July 2009- June 2012 July 2010- June 2013 NationalAverageReadmissionRate(%) Performance (measurement) Time Period Heart Failure Heart Attack Pneumonia Diagnosis of initial hospitalization
- 23. Figure 23 Other2 12% Nondefense Discretionary 17% Defense 17% Social Security 24% Medicare1 14% Medicaid, Exchange subsidies, CHIP 9% Net Interest 7% NOTE:All amounts are for federal fiscal year 2014. 1Consists of Medicare spending minus income from premiums and other offsetting receipts. 2Other category includes spending on other mandatory outlays minus income from offsetting receipts). SOURCE: Congressional Budget Office, Budget and Economic Outlook: 2015 to 2025 (January 2015). Distribution of Federal Outlays, 2014 Total Federal Outlays, 2014 = $3.5 Trillion Net Federal Medicare Outlays, 2014 = $505 Billion
- 24. Figure 24 Medicare Advantage 26% Hospital Inpatient Services 23%Physician Payments 12% Outpatient Prescription Drugs 11% Hospital Outpatient Services 7% Skilled Nursing Facilities 5% Home Health 3% Other Services* 14% NOTE: *Otherservices includes ambulance services, ambulatory surgical centers, community mental health centers, durable medical equipment, federally qualified health centers, hospice, hospital outpatient services not paid for using the outpatient prospective payment system, outpatient dialysis, outpatient therapy services, lab services, rural health clinics, Part B drugs; also includes amounts paid to providers and recovered. SOURCE: Kaiser Family Foundation analysis of data from Congressional Budget Office, 2015 Medicare Baseline (March 2015). Distribution of Medicare Benefit Payments, 2014 Total Medicare Benefit Payments, 2014 = $597 billion
- 25. Figure 25 90% 42% 10% 58% NOTE: ExcludesMedicare Advantage enrollees. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Distribution of Traditional Medicare Beneficiaries and Medicare Spending, 2010 Total Number of Traditional Medicare Beneficiaries, 2010: 36.3 million Total Traditional Medicare Spending, 2010: $385 billion Average per capita Traditional Medicare spending: $10,584 Average per capita Traditional Medicare spending among top 10%: $61,722 Average per capita Traditional Medicare spending among bottom 90%: $4,897
- 26. Figure 26 22% 43% 28% 26% 22%22% <1% Total Services Home Health Care Prescription Drugs Hospital Services Physician Services Nursing Home Care Dental Services NOTE: Total also includes durable medical equipment, other professional services, and other personal health care/products. Medicare spending does not exclude income from premiums and other offsetting receipts. Medicare coverage of nursing home care reflects spending on freestanding skilled nursing facilities only (not custodial long-term care services). SOURCE: Kaiser Family Foundation analysis of data from Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, National Health Expenditures Tables (December 2014). Percent of Personal Health Expenditures Accounted for by Medicare, 2013 Expenditures in Billions Medicare $551 $34 $75 $243 $130 $35 $0.5 Total $2,469 $80 $271 $937 $587 $156 $111
- 27. Figure 27 $446 $480 $466$492 $505 $527 $560 $562 $574 $642 $688 $738 $833 $852 $866 $981 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 NOTE: All amounts are for federal fiscal years; amounts are in billions and consist of Medicare spending minus income from premiums and other offsetting receipts. SOURCE: Kaiser Family Foundation based on data from Congressional Budget Office, Updated Budget Projections: 2015 to 2025 (March 2015); The 2014 Long-Term Budget Outlook (July 2014). Medicare Spending and Percent of Federal Outlays and GDP, 2010-2025 12.9% 13.3% 13.2% 14.2% 14.4% 14.3% 14.3% 13.9% 13.6% 14.3% 14.5% 14.8% 15.8% 15.8% 15.2% 16.2% Share of: Federal Outlays Actual Net Outlays Projected Net Outlays 3.0% 3.1% 2.9% 3.0% 2.9% 2.9% 3.0% 2.9% 2.8% 3.0% 3.1% 3.2% 3.4% 3.4% 3.3% 3.6%GDP
- 28. Figure 28 5.5% 6.1% 2.9% 2.4% 3.7% 4.7% 3.5% 2.2% NOTE: *Assumes0.6-percent physician payment rate increase from 2016 through 2023, consistent with the average update over the 10-year period ending with March 31, 2015; based on the spending data from the 2014 Medicare Trustees report. SOURCE: Kaiser Family Foundation analysis of Medicare spending data from Boards of Trustees and Congressional Budget Office (CBO); private health insurance spending data from the CMS National Health Expenditure data; GDP data from CBO and U.S. Census Bureau, and CPI data from the Bureau of Labor Statistics (historical) and CBO (projected). Historical and Projected Average Annual Growth Rate in Medicare Per Capita Spending and Other Measures Actual (2000-2013) Projected (2014-2023) Medicare per capita spending Private health insurance per capita spending GDP per capita CPI Medicare per capita spending* Private health insurance per capita spending GDP per capita CPI
- 29. Figure 29 $575.8 billion$251.1 billion $255.0 billion $69.7 billion 3% 5% 2%2% 6%2% 13% 13% 1% 25% 14% 38% 88% 41% 73% 73% TOTAL Part A Part B Part D General revenue Payroll taxes Beneficiary premiums State payments Taxation of Social Security benefits Interest and other SOURCE: Kaiser Family Foundation based on data from 2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Sources of Medicare Revenue, 2013
- 30. Figure 30 2020 2018 2019 2019 2017 2029 20242024 2026 2030 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 SOURCE: Intermediate projections from 2005-2014 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Solvency of the Medicare Part A Hospital Insurance Trust Fund Year of Medicare Trustees Report
- 31. Figure 31 39.7 47.7 64.4 81.8 89.2 92.8 4.0 3.4 2.8 2.3 2.22.3 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 0 10 20 30 40 50 60 70 80 90 100 2000 2010 2020 2030 2040 2050 Number of beneficiaries (in millions) Number of workers per beneficiary SOURCE: Kaiser Family Foundation based on the 2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Number of Medicare Beneficiaries and Number of Workers Per Beneficiary, 2000-2050 In millions