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Medicare: The Essentials
1. 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 43.3
2.2
3.0
2.9
3.3
4.4
5.4
6.7 7.0 7.3 7.5 7.8 8.0 8.4
8.5
8.7
19.1 20.5
25.0
28.5
31.1
34.2
37.6
39.6
42.5 43.3 44.3 45.4 46.5 47.7 48.8
50.4
52.0
1966 1970 1975 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nonelderly Disabled (Under Age 65) Elderly (Age 65 and Older)
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
2. 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
DC13%
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%
3. 20.4
24.9
28.4
31.1
34.3
37.6 39.7
42.6
47.7
55.6
64.3
73.5
81.5
86.5
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.
Medicare Enrollment, 1970-2035
Historical ProjectedIn millions:
5. 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 Population
Percent 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
7. 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
8. 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
9. 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%Enrollee
pays 5%
Enrollee
pays
25%
Catastrophic
Coverage Limit =
$6,955 in
Estimated
Total Drug Costs
Brand-name drugs
Enrollee pays 47.5%;
Plan pays 2.5%
50% manufacturer discount
Generic drugs
Enrollee pays 79%;
Plan pays 21%
INITIAL
COVERAGE
PERIOD
COVERAGE
GAP
CATASTROPHIC
COVERAGE
DEDUCTIBLE
10. 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 plans
12 states, DC 18 states 13 states 7 states
U.S. Total, 2013= 1,031
DC29
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
32
29
28
29
30
28
30
32
33
31
30
38
31
32
33
32
32
30
31
30
38
32
30
33
11. Part D non-LIS
enrollees
24.4 million
47%
Part D LIS
enrollees
11.3 million
22%
Employer subsidy
3.2 million
All other
13.4 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 million
Total Part D Enrollment (excluding employer subsidy) = 35.7 million
6%
12. 6.9 6.8
6.2
5.6 5.3 5.3 5.6
6.8
8.4
9.7
10.5
11.1
11.9
13.1
14.4
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
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%
13. Traditional
Fee-for-service
Medicare
72%
HMO 65%
Local PPO 22%
Regional PPO 7%
PFFS 3%
Other 3%
Medicare
Advantage
28%
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
14. 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%
15. 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
Medicare
37 million
Medicaid
51 million
Total Medicare beneficiaries, 2008:
46 million
Total Medicaid beneficiaries, 2008:
60 million
16. 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:
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%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
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
19. 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%
51.8%
56.3%
59.2% 58.4% 59.8%
57.9% 57.8%
0%
10%
20%
30%
40%
50%
60%
70%
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.
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)
20. 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
21. Distribution of Average Household Spending by
Medicare and Non-Medicare Households, 2010
Housing
$10,940
36%
$4,106
13%
$4,527
15%
Food
$4,766
15%
Other
$6,480
21%
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 =
$49,641
Average Household Spending =
$30,818
Health Care
Transportation
Housing
$16,824
34%
$8,188
16% $2,450
Food
$7,364
15%
Other
$14,815
30%
Health
Care
5%
Transportation
22. Other2
13%
Nondefense
Discretionary
17%
Defense
19%
Social Security
22%
Medicare1
16%
Medicaid
7%
Net Interest
6%
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 Trillion
Federal Spending on Medicare, FY2012 = $551 Billion
24. 8.5%
12.1%
15.1%
16.9%
1990 2000 2010 2020
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
1.9%
2.2%
3.6% 3.7%
1990 2000 2010 2020
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
25. 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
Services
26%
5%
Physician
Payments
13%
6%4%
Other
Services
13%
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
26. 21%
44%
28%
25% 24% 24%
Total
Services*
Home Health
Care
Hospital
Services
Prescription
Drugs
Physician
Services
Nursing Home
Care
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 $38
Total $2,809 $78 $885 $277 $550 $155
27. 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
28. 0%
5%
10%
15%
20%
25%
1970 1975 1980 1985 1990 1995 2000 2005 2010
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
Medicare
Private Health Insurance
29. $532.6 billion $241.7 billion $229.1 billion $61.7 billion
4% 6% 3%
3%
8%2%
13%
13% 2% 25%
13%
38%
85%
40%
72% 73%
TOTAL Part A Part B Part D
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
30. 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
31. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2012 2014 2016 2018 2020 2022 2024 2026
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, 2012-2026
In billions:
