Medicare Enrollment, 1966 - 2013

Report
Medicare Enrollment, 1966-2013
Elderly (Age 65 and Older)
Nonelderly Disabled (Under Age 65)
50.4
37.6
34.2
31.1 3.3
28.5
25.0 3.0
4.4
39.6
5.4
47.7 48.8
46.5
44.3 45.4
43.3
8.5
42.5
8.4
8.0
6.7
7.0
7.3
7.5
19.1
20.5
25.5
8.7
7.8
2.9
2.2
19.1 20.5
22.8
52.0
28.2
31.0
33.2
34.3
35.8
36.3
37.0
37.9
38.8
39.6
40.5
41.9
43.3
1966 1970 1975 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013
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 Beneficiaries as a Percent of State Populations,
2012
National Average, 2012 = 16%
15%
19%
18%
16%
15%
17%
15%
17%
16%
11%
13%
15%
13%
16%
17%
18%
15%
14%
17%
16%
17%
16%
18%
17%
15% 16%
21%15%
17%
18%
16%
17%
18%
19%
17% 18% 13%
16%
12%
10%
21%
19%
16%
10% - 14%
15% – 16%
17% – 18%
19% – 21%
8 states, DC
18 states
19 states
5 states
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.
18%
17%
18%
16%
16%
17%
14%
DC 13%
Medicare Enrollment, 1970-2035
Historical
In millions:
Projected
86.5
81.5
73.5
64.3
55.6
47.7
24.9
28.4
31.1
34.3
37.6
39.7
42.6
20.4
1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
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
100
92.4
88.9
90
9%
81.5
80
8%
64.3
70
60
50
40
7%
6%
47.7
5%
39.7
4%
3.0%
30
3%
2.4%
1.9%
20
2%
0.9%
10
0
10%
2000
2010
2020
2030
1%
0.4%
2040
SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical
Insurance Trust Funds.
2050
0%
Characteristics of the Medicare Population
Percent of total Medicare population:
Income below $22,502
50%
Savings below $77,482
50%
3+ Chronic Conditions
40%
Fair/Poor Health
27%
Cognitive/Mental
Impairment
Dually Eligible for
Medicare and Medicaid
23%
20%
17%
Under-65 Disabled
15%
2+ ADL Limitations
13%
Age 85+
Long-term Care
Facility Resident
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.
Median Income Among Medicare Beneficiaries, Overall
and by Race/Ethnicity, Age, and Gender, 2012
Race /Ethnicity
Age
$24,797
$23,809
$22,502
Gender
$24,625
$22,699
$20,920
$17,410
$16,183
$15,252
$13,805
Total
White
Black Hispanic
Under
age 65
Age
65-74
SOURCE: Urban Institute analysis of DYNASIM for the Kaiser Family Foundation.
Age Age 85
75-84 or older
Male
Female
Distribution of Medicare Beneficiaries by Income Level,
2012
5% had incomes above $88,900
50% had incomes below $22,500
25% had incomes below $14,000
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.
Medicare Beneficiaries’ Utilization of Selected Medical
and Long-Term Care Services, 2009
Percent of total Medicare population:
77%
Physician Office Visit
28%
Emergency Room Visit
19%
Inpatient Hospital Stay
9%
Home Health Visit
Skilled Nursing
Facility Stay
Hospice Visits
5%
2%
SOURCES: Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary 2009
Cost and Use file.
Standard Medicare Prescription Drug Benefit, 2013
CATASTROPHIC
COVERAGE
COVERAGE
GAP
INITIAL
COVERAGE
PERIOD
DEDUCTIBLE
Enrollee
pays 5%
Plan pays 15%; Medicare pays 80%
Brand-name drugs
Enrollee pays 47.5%;
Plan pays 2.5%
50% manufacturer discount
Generic drugs
Enrollee pays 79%;
Plan pays 21%
Enrollee
pays
25%
Catastrophic
Coverage Limit =
$6,955 in
Estimated
Total Drug Costs
Initial Coverage
Limit = $2,970 in
Total Drug Costs
Plan pays 75%
Deductible = $325
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.
Number of Medicare Part D Stand-Alone Prescription
Drug Plans, by State, 2013
U.S. Total, 2013= 1,031
30
30
32
32
32
30
33
32
32
32
29
32
32
29
29
28
30
32
32
32
31
31
30
31
38
33
31
38
32
31
30
29 33
30
32
23
34
23
30 – 31 plans
18 states
32 plans
13 states
31
30
33
30
23 – 29 plans
12 states, DC
28
33 – 38 plans
7 states
SOURCE: Kaiser Family Foundation analysis of Centers for Medicare & Medicaid Services (CMS) PDP landscape source file, 2013.
28
30
30
30
29
29
29
DC 29
Prescription Drug Coverage Among Medicare
Beneficiaries in 2013
Part D non-LIS
enrollees
24.4 million
All other
13.4 million
26%
6%
Employer subsidy
3.2 million
47%
Part D LIS
enrollees
11.3 million
22%
Total Medicare Enrollment in 2013= 52.3 million
Total Part D Enrollment (excluding employer subsidy) = 35.7 million
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.
Total Medicare Private Health Plan Enrollment, 1999-2013
14.4
In millions:
13.1
9.7
10.5
11.1
11.9
8.4
6.9 6.8
6.2
6.8
5.6 5.3 5.3 5.6
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
% of Medicare
18% 17% 15% 14% 13% 13% 13% 16% 19% 22% 23% 24% 25% 27% 28%
Beneficiaries
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.
Distribution of Enrollment in Medicare Advantage Plans,
by Plan Type, 2013
HMO 65%
Traditional
Fee-for-service
Medicare
72%
Medicare
Advantage
28%
Local PPO 22%
Regional PPO 7%
PFFS 3%
Other 3%
Total Medicare Advantage Enrollment, 2013 = 14.4 Million
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.
Share of Medicare Beneficiaries Enrolled in Medicare
Advantage Plans, by State, 2013
National Average, 2013 = 28%
28%
15%
7%
12%
49%
42%
27%
3%
12%
32%
33%
37%
38%
35%
33%
33%
13%
30%
14%
12%
16%
29%
37%
11% 21%
21% 15%
22%
24%
20%
29%
20%
17%
12% 22% 25%
26%
27%
0%
39%
17%
5%
18%
35%
23%
16%
7%
8%
DC 10%
36%
46%
< 10%
10% - 19%
20% - 29%
≥30%
(6 states)
(14 states + DC)
(15 states)
(15 states)
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.
Dually eligible beneficiaries comprise 20% of the Medicare
population and 15% of the Medicaid population, 2008
Medicare
37 million
Dual
Eligibles
9 million
Total Medicare beneficiaries, 2008:
46 million
Medicaid
51 million
Total Medicaid beneficiaries, 2008:
60 million
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.
Dual eligible beneficiaries as a share of Medicare and
Medicaid population and spending, 2008
Dual Eligibles as a Share of the
Medicare Population and Medicare
Spending, 2008:
80%
20%
Total Medicare
Population, 2008:
46 Million
Dual Eligibles as a Share of the
Medicaid Population and Medicaid
Spending, 2008:
61%
69%
85%
39%
31%
15%
Total Medicare
Spending, 2008:
$424 Billion
Total Medicaid
Population, 2008:
60 Million
Total Medicaid
Spending, 2008:
$330 Billion
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.
Sources of Supplemental Coverage Among Medicare
Beneficiaries, 2009
No Supplemental
Coverage
Other Public/Private
12%
1%
Medicaid
15%
Medigap
15%
EmployerSponsored
31%
Medicare
Advantage
25%
Total Number of Beneficiaries, 2009: 47.2 Million
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.
Median Out-of-Pocket Health Care Spending As a Percent
of Income Among Medicare Beneficiaries, 1997-2006
18%
16%
14.9%
16.2%
14.0%
14%
12%
15.5% 15.6% 15.6%
11.9% 11.8% 12.0%
Total health care
out-of-pocket
12.8%
10%
8%
6%
4%
5.5%
5.3%
5.4%
4.1%
4.2%
4.4%
1997
1998
1999
5.5%
6.0%
6.5%
6.7%
6.9%
7.4%
8.0% Premium
out-of-pocket
5.5%
5.8%
5.6%
4.9%
5.2%
5.5%
5.4%
2000
2001
2002
2003
2004
2005
2006
Nonpremium
out-of-pocket
2%
0%
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.
Out-of-Pocket Health Care Spending As a Percent of
Income Among Medicare Beneficiaries, By Spending
Percentile, 1997-2006
70%
60%
50%
56.3%
47.5%
49.1%
50.0%
59.2%
58.4%
59.8%
57.9%
57.8%
90th percentile
51.8%
40%
30%
23.9%
23.9%
24.9%
26.2%
27.4%
29.2%
29.9%
30.1%
29.9%
30.1%
75th percentile
20%
10%
14.9% 15.5% 15.6% 15.6% 16.2%
14.0%
11.9% 11.8% 12.0% 12.8%
0%
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
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.
50th percentile
(median)
Part B and Part D Out-of-Pocket Spending as a Share of
Average Social Security Benefit, 1970-2010
1970
1980
6%
7%
1990
12%
2000
2010
14%
26%
$604
Average Monthly Social Security benefit payment
$772
$906
$1,001
$1,151
$39
Average monthly out-of-pocket spending on Part B and Part D
$53
$111
$136
$299
NOTE: SMI is Supplementary Medical Insurance. Out-of-pocket spending includes SMI (Part B and Part D) premiums and out-ofpocket 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.
Distribution of Average Household Spending by
Medicare and Non-Medicare Households, 2010
Medicare Household Spending
Non-Medicare Household Spending
Transportation
$4,106
13%
Housing
$10,940
36%
Health Care
$4,527
15%
Other
$6,480
21%
Food
$4,766
15%
Average Household Spending =
$30,818
Housing
$16,824
34%
Health
Transportation
Care
$8,188
16%
$2,450 5%
Food
$7,364
15%
Other
$14,815
30%
Average Household Spending =
$49,641
SOURCE: Kaiser Family Foundation analysis of the Bureau of Labor Statistics Consumer Expenditure Survey Interview and Expense
Files, 2010.
Medicare as a Share of the Federal Budget, 2012
Social Security
22%
Defense
19%
Medicare1
16%
Nondefense
Discretionary
17%
Other2
Medicaid
13%
7%
Net Interest
6%
Total Federal Spending, FY2012 = $3.5 Trillion
Federal Spending on Medicare, FY2012 = $551 Billion
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.
Projected Medicare Spending, 2013-2023
In billions:
$1,018
$794
$586
$597
$615
2013
2014
2015
$671
$695
$722
2016
2017
2018
SOURCE: Congressional Budget Office (CBO) Medicare Baseline, May 2013.
2019
$849
2020
$1,064
$911
2021
2022
2023
Medicare as a share of Federal Budget Outlays, and as
a share of Gross Domestic Product (GDP), 1990-2020
Medicare Spending as a Share
of Federal Budget Outlays
Medicare Spending as a Share
of Gross Domestic Product (GDP)
16.9%
3.6%
3.7%
2010
2020
15.1%
12.1%
2.2%
1.9%
8.5%
1990
2000
2010
2020
Total Federal Outlays (trillions)
$1.3
$1.8
$3.5
$5.0
1990
2000
Gross Domestic Product (trillions)
$5.7
$9.8
$14.5
$22.9
SOURCE: CBO Budget and Economic Outlook, January 2011 (for 1990-2010 data) and May 2013 (for 2020 data).
Medicare Benefit Payments By Type of Service, 2012
Outpatient
Prescription
Drugs
10%
Medicare
Advantage
Part A
Part B
Part A and B
Part C
Part D
Hospital
Inpatient
Services
26%
23%
5%
Other
Services
Physician
Payments
13%
13%
Skilled Nursing
Facility
4% 6%
Home Health
Hospital Outpatient
Services
Total Benefit Payments = $536 billion
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’s Share of National Personal Health
Expenditures, by Type of Service, 2012
44%
28%
25%
24%
24%
Prescription
Drugs
Physician
Services
Nursing Home
Care
21%
Total
Services*
Home Health
Care
Hospital
Services
Expenditures in Billions (Projected)
Medicare
Total
$591
$34
$250
$69
$131
$38
$2,809
$78
$885
$277
$550
$155
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.
Distribution of Traditional Medicare Beneficiaries and
Medicare Spending, 2009
10%
Average per capita
Traditional Medicare
spending: $9,702
57%
Average per capita
Traditional Medicare
spending among
top 10%: $55,763
90%
43%
Total Number of Traditional
Medicare Beneficiaries:
Total Traditional
Medicare Spending:
35.4 million
$343 billion
Average per capita
Traditional Medicare
spending among
bottom 90%: $4,584
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.
Annual Change in Per Enrollee Medicare and Private
Health Insurance Spending, 1970-2011
Medicare (Average Annual Growth, 1970-2011 = 7.9%)
25%
Private Health Insurance (Average Annual Growth, 1970-2011 = 9.1%)
Medicare
20%
Private Health Insurance
15%
10%
5%
0%
1970
1975
1980
1985
1990
1995
2000
2005
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.
2010
Sources of Medicare Revenue, 2012
General revenue
40%
Payroll taxes
72%
73%
85%
Beneficiary
premiums
State payments
38%
Taxation of Social
Security benefits
13%
2%
25%
8%
6%
2%
3%
4%
13%
Interest and other
13%
3%
TOTAL
Part A
Part B
Part D
$532.6 billion
$241.7 billion
$229.1 billion
$61.7 billion
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.
Historical and Projected Average Annual Growth Rate
in Medicare Spending Per Capita and Other Measures
Projected (2012-2021)
Actual (2000-2011)
6.6%
6.9%
5.0%
4.1%
2.9%
Medicare
spending
per capita
Private health
insurance
spending
per capita
GDP
per capita
3.2%
2.5%
CPI
2.1%
Medicare
spending
per capita*
Private health
insurance
spending
per capita
GDP
per capita
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.
CPI
Medicare Part A Trust Fund Balance at Beginning of the
Year, as a Percentage of Annual Expenditures, 2012-2026
In billions:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2012
2014
2016
2018
2020
2022
2024
SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical
Insurance Trust Funds.
2026
Solvency Projections of the Medicare Part A Trust Fund,
1970-2013
Projected Number of Years to Insolvency and Projected Year of Insolvency:
Year of
Trustees’
Report
1970
1980
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2
1972
14
13
14
1994
2003
2005
10
2002
6
1999
7
2001
6
2001
5
2001
4
2001
10
16
2008
2015
25
2025
28
28
2029
2030
23
2026
15
15
2019
2020
12
12
11
8
2018
2019
2019
2017
19
13
12
13
2029
2024
2024
2026
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.

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