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1966 1970 1975 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013
19.1 20.5 22.8 25.5 28.2 31.0 33.2 34.3 35.8 36.3 37.0 37.9 38.8 39.6 40.5 41.9 43.32.168
2.9632.907
3.2524.409
5.3716.723 7.022 7.297 7.516 7.755 8.033 8.375 8.5
8.7
19.1 20.525.0
28.531.1
34.237.6
39.642.5 43.3 44.3 45.4 46.5 47.7 48.8 50.4 52.0
Elderly (Age 65 and Older) Nonelderly Disabled (Under Age 65)
NOTES: Numbers may not sum to total due to rounding. People with disabilities under age 65 were not eligible for Medicare prior to 1972.SOURCE: Centers for Medicare & Medicaid Services, Medicare Enrollment: Hospital Insurance and/or Supplemental Medical Insurance Programs for Total, Fee-for-Service and Managed Care Enrollees as of July 1, 2011: Selected Calendar Years 1966-2011; 2012-2013, HHS Budget in Brief, FY2014.
Medicare Enrollment, 1966-2013
SOURCE: Calculation based on Kaiser Family Foundation analysis of the CMS State/County Market Penetration file, March 2012; and 2011 population estimates from the United States Census Bureau.
Medicare Beneficiaries as a Percent of State Populations, 2012
National Average, 2012 = 16%
10% - 14% 15% – 16% 17% – 18% 19% – 21%8 states, DC 18 states 19 states 5 states
DC 13%
18%
18%
10%
15% 19%
13% 13%
16%
17%
19%
13%
16%
15%
15%16%
17%
16% 18%
16%
21%
14%
17%15%
17%
17%
18%
16%14%
18%
16%
16%
16%
16%
16%
17%
17%
17%
18%
18%
17%
17%
12%
11%
19%
15%
15%
21%
15%
17%18%
1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
20.424.9
28.431.1
34.337.6 39.7
42.647.7
55.6
64.3
73.5
81.586.5
SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Medicare Enrollment, 1970-2035
Historical ProjectedIn millions:
0
10
20
30
40
50
60
70
80
90
100
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
1.9%
3.0%2.4%
0.9%0.4%
39.747.7
64.3
81.588.9
92.4
SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Projected Change in Medicare Enrollment, 2000-2050
Medicare Enrollment (in millions)
Average Annual Growth in Enrollment
50%
50%
40%
27%
23%
20%
17%
15%
13%
5%
NOTE: ADL is activity of daily living. SOURCE: Urban Institute and Kaiser Family Foundation analysis, 2012; Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary 2009 Cost and Use file.
Characteristics of the Medicare PopulationPercent of total Medicare population:
Income below $22,502
Savings below $77,482
3+ Chronic Conditions
Fair/Poor Health
Cognitive/Mental Impairment
Dually Eligible for Medicare and Medicaid
Under-65 Disabled
2+ ADL Limitations
Age 85+
Long-term Care Facility Resident
Total White Black Hispanic Underage 65
Age 65-74
Age75-84
Age 85 or older
Male Female
22502
24797
1525213805
16183
2380922699
17410
24625
20920
SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.
Median Income Among Medicare Beneficiaries, Overall and by Race/Ethnicity, Age, and Gender, 2012
Race /Ethnicity Age Gender
25% had incomes below $14,000
50% had incomes below $22,500
5% had incomes above $88,900
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 Level, 2012
Percent of total Medicare population:
2%
5%
9%
19%
28%
77%
SOURCES: Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary 2009 Cost and Use file.
Medicare Beneficiaries’ Utilization of Selected Medical and Long-Term Care Services, 2009
Physician Office Visit
Emergency Room Visit
Inpatient Hospital Stay
Home Health Visit
Skilled Nursing Facility Stay
Hospice Visits
NOTE: *Amount corresponds to the estimated catastrophic coverage limit for non-LIS enrollees ($6,734 for LIS enrollees), which corresponds to TrOOP spending of $4,750.SOURCE: Kaiser Family Foundation illustration based on CMS standard benefit parameter update for 2013. Amounts rounded to nearest dollar.
Standard Medicare Prescription Drug Benefit, 2013
Deductible = $325
Initial Coverage Limit = $2,970 in Total Drug Costs
Plan pays 75%
Plan pays 15%; Medicare pays 80%Enrolleepays 5%
Enrollee pays 25%
CatastrophicCoverage Limit =
$6,955 in Estimated
Total Drug Costs
Brand-name drugs Enrollee pays 47.5%;
Plan pays 2.5%50% manufacturer discount
Generic drugsEnrollee pays 79%;
Plan pays 21%
INITIAL COVERAGE
PERIOD
COVERAGE GAP
CATASTROPHIC COVERAGE
DEDUCTIBLE
SOURCE: Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services (CMS) PDP landscape source file, 2013.
Number of Medicare Part D Stand-Alone Prescription Drug Plans, by State, 2013
23 – 29 plans 30 – 31 plans 32 plans 33 – 38 plans12 states, DC 18 states 13 states 7 states
U.S. Total, 2013= 1,031
DC 29
30
33
23
29 30
32 29
30
29
34
30
23
32
32 31
32
31 32
30
28
29
3032
29
31
32
3229
28
29
30
28
30
32
33
31
30
38
31
32
33
32
32
30
31
30
38
32
3033
Part D non-LIS enrollees24.4 million
47%
Part D LIS enrollees
11.3 million22%
Employer subsidy3.2 million
All other13.4 million
26%
NOTE: Does not sum to 100% due to rounding. LIS is low-income subsidy. Total Part D and Medicare enrollment based on 2012 intermediate estimates. SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Prescription Drug Coverage Among Medicare Beneficiaries in 2013
Total Medicare Enrollment in 2013= 52.3 millionTotal Part D Enrollment (excluding employer subsidy) = 35.7 million
6%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
6.9 6.86.2
5.6 5.3 5.3 5.66.8
8.49.7
10.511.1
11.913.1
14.4
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, 2008-2013, and MPR, “Tracking Medicare Health and Prescription Drug Plans Monthly Report,” 2001-2007; enrollment numbers from March of the respective year, with the exception of 2006, which is from April.
Total Medicare Private Health Plan Enrollment, 1999-2013
In millions:
% of Medicare Beneficiaries 18% 17% 15% 14% 13% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28%
TraditionalFee-for-service
Medicare 72%
HMO 65%
Local PPO 22%Regional PPO
7%PFFS 3%
Other 3%
NOTE: PFFS is Private Fee-for-Service plans, PPOs are preferred provider organizations, and HMOs are Health Maintenance Organizations. Other includes MSAs, cost plans, and demonstration plans. Includes enrollees in Special Needs Plans as well as other Medicare Advantage plans. SOURCE: MPR / KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage enrollment files, 2013.
Distribution of Enrollment in Medicare Advantage Plans, by Plan Type, 2013
Total Medicare Advantage Enrollment, 2013 = 14.4 Million
NOTE: Includes MSAs, 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, 2013.
Share of Medicare Beneficiaries Enrolled in Medicare Advantage Plans, by State, 2013
National Average, 2013 = 28%
< 10% 10% - 19% 20% - 29% ≥30%(6 states) (14 states + DC) (15 states) (15 states)
DC 10%
35%
22%
0%
38% 17%
37% 35%
23%
7%
36%
25%
46%
30%
11% 21%
14%
12% 22%
26%
17%
8%
18%49%
12%
24%
15%
12%32%
5%
16%
29%
33%
20%
12%
37%
16%
42%
39%
20%
13%
29%
27%
33%
7%
15%
28%
21%
3%33%
27%
SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2008, and Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY2008 MSIS and CMS Form-64.
Dually eligible beneficiaries comprise 20% of the Medicare population and 15% of the Medicaid population, 2008
Dual Eligibles
9 million
Medicare37 million
Medicaid51 million
Total Medicare beneficiaries, 2008: 46 million
Total Medicaid beneficiaries, 2008: 60 million
20%31%
15%
39%
80%69%
85%
61%
SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2008, and Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY2008 MSIS and CMS Form-64.
Dual eligible beneficiaries as a share of Medicare and Medicaid population and spending, 2008
Total Medicare Spending, 2008:
$424 Billion
Total Medicare Population, 2008:
46 Million
Total Medicaid Spending, 2008:
$330 Billion
Total Medicaid Population, 2008:
60 Million
Dual Eligibles as a Share of the Medicare Population and Medicare
Spending, 2008:
Dual Eligibles as a Share of the Medicaid Population and Medicaid
Spending, 2008:
Employer-Sponsored31%
Medicare Advantage
25%
Medigap15%
Medicaid15%
Other Public/Private1%
12%
NOTE: Numbers do not sum due to rounding.SOURCE: Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary Survey, 2009 Cost and Use file.
Sources of Supplemental Coverage Among Medicare Beneficiaries, 2009
Total Number of Beneficiaries, 2009: 47.2 Million
No Supplemental Coverage
1997 1998 1999 2000 2001 2002 2003 2004 2005 20060%
2%
4%
6%
8%
10%
12%
14%
16%
18%
11.9% 11.8% 12.0%12.8%
14.0%14.9%
15.5% 15.6% 15.6%16.2%
5.5% 5.3% 5.4% 5.5%6.0%
6.5% 6.7% 6.9%7.4%
8.0%
4.1% 4.2% 4.4% 4.9% 5.2% 5.5% 5.8% 5.6% 5.5% 5.4%
NOTES: Differences between 1997 and 2006 are statistically significant for all displayed measures. Annual amounts for the components of total health care spending do not sum to total amounts because values shown are median, not mean, values.SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey Cost and Use files, 1997-2006.
Median Out-of-Pocket Health Care Spending As a Percent of Income Among Medicare Beneficiaries, 1997-2006
Total health care out-of-pocket
Premium out-of-pocket
Nonpremium out-of-pocket
1997 1998 1999 2000 2001 2002 2003 2004 2005 20060%
10%
20%
30%
40%
50%
60%
70%
11.9% 11.8% 12.0% 12.8% 14.0% 14.9% 15.5% 15.6% 15.6% 16.2%
23.9% 23.9% 24.9% 26.2% 27.4% 29.2% 29.9% 30.1% 29.9% 30.1%
47.5% 49.1% 50.0% 51.7%56.3%
59.2% 58.4% 59.8%57.9% 57.8%
NOTES: Differences between 1997 and 2006 are statistically significant for all displayed measures. SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey Cost and Use files, 1997-2006.
Out-of-Pocket Health Care Spending As a Percent of Income Among Medicare Beneficiaries, By Spending Percentile, 1997-2006
90th percentile
75th percentile
50th percentile (median)
NOTE: SMI is Supplementary Medical Insurance. Out-of-pocket spending includes SMI (Part B and Part D) premiums and out-of-pocket cost-sharing expenses for SMI covered services. SOURCE: Kaiser Family Foundation analysis based on data from 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Part B and Part D Out-of-Pocket Spending as a Share of Average Social Security Benefit, 1970-2010
Average Monthly Social Security benefit payment$604 $772 $906 $1,001 $1,151
Average monthly out-of-pocket spending on Part B and Part D$39 $53 $111 $136 $299
6% 7% 12% 14%26%
1970 1980 1990 2000 2010
Distribution of Average Household Spending by Medicare and Non-Medicare Households, 2010
Housing1094035%
$4,106 13%
$4,527 15%
Food476615%
Other648021%
SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense Files, 2010.
Non-Medicare Household SpendingMedicare Household Spending
Average Household Spending = $49,641Average Household Spending = $30,818
Health Care
Transportation
Housing1682434%
$8,188 16% $2,450
Food736415%
Other1481530%
Health Care5%
Transportation
Other213%
Nondefense Discretionary
17%
Defense19%
Social Security22%
Medicare116%
Medicaid7%
Net Interest6%
Chart Title
NOTE: FY is fiscal year. 1Amount for Medicare excludes offsetting premium receipts (premiums paid by beneficiaries, amount paid to providers and later recovered, and state contribution (clawback) payments to Medicare Part D). 2Other category includes other mandatory outlays, offsetting receipts, and negative outlays for Troubled Asset Relief Program (TARP).SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.
Medicare as a Share of the Federal Budget, 2012
Total Federal Spending, FY2012 = $3.5 TrillionFederal Spending on Medicare, FY2012 = $551 Billion
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
$586 $597 $615 $671 $695 $722
$794 $849
$911
$1,018 $1,064
SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.
Projected Medicare Spending, 2013-2023
In billions:
1990 2000 2010 2020
8.5%
12.1%
15.1%16.9%
SOURCE: CBO Budget and Economic Outlook, January 2011 (for 1990-2010 data) and May 2013 (for 2020 data).
Medicare as a share of Federal Budget Outlays, and as a share of Gross Domestic Product (GDP), 1990-2020
1990 2000 2010 2020
1.9%2.2%
3.6% 3.7%
Medicare Spending as a Share of Federal Budget Outlays
Medicare Spending as a Share of Gross Domestic Product (GDP)
Total Federal Outlays (trillions)$1.3 $1.8 $3.5 $5.0
Gross Domestic Product (trillions)$5.7 $9.8 $14.5 $22.9
NOTE: Excludes administrative expenses and is net of recoveries. *Includes hospice, durable medical equipment, Part B drugs, outpatient dialysis, ambulance, lab services, and other services.SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.
Medicare Benefit Payments By Type of Service, 2012
Total Benefit Payments = $536 billion
Hospital Inpatient Services26%
5%
Physician Payments
13%
6%4%
Other Services13%
Medicare Advantage
23%
Outpatient Prescription Drugs
10%
Home Health Hospital Outpatient Services
Skilled Nursing Facility
Part A Part B Part A and B Part C Part D
Total Services*
Home Health Care
Hospital Services
Prescription Drugs
Physician Services
Nursing Home Care
21%
44%
28%25% 24% 24%
NOTE: Total also includes dental care, durable medical equipment, other professional services, and other personal health care/products.SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Expenditure Projections 2011-2021, June 2012.
Medicare’s Share of National Personal Health Expenditures, by Type of Service, 2012
Expenditures in Billions (Projected)Medicare $591 $34 $250 $69 $131 $38Total $2,809 $78 $885 $277 $550 $155
90%
43%
10%
57%
NOTES: Excludes Medicare Advantage enrollees. Includes noninstitutionalized and institutionalized beneficiaries.SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2009.
Distribution of Traditional Medicare Beneficiaries and Medicare Spending, 2009
Total Number of Traditional Medicare Beneficiaries:
35.4 million
Total Traditional Medicare Spending:
$343 billion
Average per capita Traditional Medicare
spending: $9,702
Average per capita Traditional Medicare
spending among top 10%: $55,763
Average per capita Traditional Medicare
spending among bottom 90%: $4,584
19701972
19741976
19781980
19821984
19861988
19901992
19941996
19982000
20022004
20062008
20100%
5%
10%
15%
20%
25% Medicare (Average Annual Growth, 1970-2011 = 7.9%)Private Health Insurance (Average Annual Growth, 1970-2011 = 9.1%)
NOTE: Comparison includes benefits commonly covered by Medicare and Private Health Insurance. These benefits are hospital services, physician and clinical services, other professional services and durable medical products.SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group: National Health Expenditure Historical Data, 2013.
Annual Change in Per Enrollee Medicare and Private Health Insurance Spending, 1970-2011
Annu
al P
erce
nt C
han g
e
Medicare
Private Health Insurance
$532.6 billion $241.7 billion $229.1 billion $61.7 billion
TOTAL Part A Part B Part D4% 6% 3%3%
8%0.0155839279008637 0.13452188006483
13% 2% 25%13%
38%
85%
0.395418700713481
0.721518987341772
0.73419773095624
General revenue
Payroll taxes
Beneficiary premiums
State payments
Taxation of Social Security benefits
Interest and other
NOTE: Numbers may not sum due to rounding. Amounts are fiscal year totals. SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Sources of Medicare Revenue, 2012
6.6%6.9%
2.9%2.5%
3.2%
5.0%
4.1%
2.1%
NOTE: *Assumes no reduction in physician fees under Medicare between 2012 and 2021.SOURCES: Kaiser Family Foundation analysis of data from Boards of Trustees, Congressional Budget Office, Centers for Medicare & Medicaid Services, U.S. Census Bureau.
Historical and Projected Average Annual Growth Rate in Medicare Spending Per Capita and Other Measures
Actual (2000-2011) Projected (2012-2021)
Medicare spending per capita
Private health insurance spending per capita
GDP per capita
CPI Medicare spending
per capita*
Private health insurance spending per capita
GDP per capita
CPI
2012 2014 2016 2018 2020 2022 2024 20260%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Medicare Part A Trust Fund Balance at Beginning of the Year, as a Percentage of Annual Expenditures, 2012-2026In billions:
20132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019801970
1312
1319
811
1212
1515
232828
2516
104
56
76
1014
1314
2
20262024
20242029
20172019
20192018
20202019
202620302029
20252015
20082001
20012001
20011999
20022005
20031994
1972
NOTES: ‘Insolvency’ refers to the depletion of the trust fund. No insolvency projections were made for 1973-1975 and 1989. For all other years not displayed, the Hospital Insurance Trust Fund was projected to remain solvent for 17 or fewer years.SOURCE: Intermediate projections from 1970-2013 Annual Reports of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Solvency Projections of the Medicare Part A Trust Fund, 1970-2013
Year ofTrustees’Report
Projected Number of Years to Insolvency and Projected Year of Insolvency:
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