Figure 1

Gender Race/Ethnicity AgeSOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file.

Selected Demographic Characteristics of Medicare Beneficiaries, 2010

Male45%

Female55%

White77%

Black10%

Hispanic 9%

75-8427%

<6516%

65-7444%

85+13%

Other 5%

Figure 2

45%

34%

31%

26%

NOTE: ADL is 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

Figure 3

25%: incomes below $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

Figure 4

Percent of Traditional 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

Figure 5

Housing16975.88

789232.0%

9660.2655154

18.2%

2771.86148

545.2%

Food7890.427

785814.9%Other

15701.64814329.6%

Housing $11,673*

34.3%

$5,087* 15.0% Health Care

$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

TransportationTransportation

Health Care

Non-Medicare Household SpendingMedicare Household Spending

Average Household Spending, 2012 = $53,000

Average Household Spending, 2012 = $33,993*

Figure 6

42%$2,000

18%

14%

11%

6%3%3%2%1%

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). 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

DentalInpatient hospitalSkilled nursing facilityOutpatient hospitalHome health

Premiums Services

Figure 7

Excellent Very good Good Fair Poor Under 65 65-74 75-84 85+

$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 ServicesPremiums

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

Figure 8

NOTE: *Amount corresponds 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%Enrolleepays 5%

Enrollee pays 25%

CatastrophicCoverage Limit =

$7,062 in Estimated

Total Drug Costs*Brand-name drugs Enrollee pays 45%

Plan pays 5%50% manufacturer discount

Generic drugsEnrollee pays 65%

Plan pays 35%

INITIAL COVERAGE

PERIOD

COVERAGE GAP

(“Doughnut Hole”)

CATASTROPHIC COVERAGE

DEDUCTIBLE Enrollee pays 100%

Figure 9

Part D non-LIS enrollees26.6 million

49%

Part D LIS enrollees

11.5 million21%

Employer subsidy2.6 million

All other13.3 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 millionTotal Part D Enrollment (excluding employer plans), 2014 = 38.1 million

5%

Figure 10

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

6.9 6.8 6.2 5.6 5.3 5.3 5.66.8

8.49.7

10.5 11.111.9

13.114.4

15.7

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%

Figure 11

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, 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%

Figure 12

SOURCE: Kaiser Family 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

Figure 13

1988 1991 1993 1995 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

66%

46%

36%40% 40% 40%

34%37% 35% 36% 35%

32% 34% 32%29% 28% 26% 26% 25%

28%25%

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

Figure 14

SOURCE: Kaiser Family 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 millionMedicare

40 millionMedicaid

56 million

Total Medicare beneficiaries, 2010:

50 millionTotal Medicaid beneficiaries, 2010:

66 million

Figure 15

80%66%

86%66%

20%34%

14%34%

Dual-eligible beneficiaries Non-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

Figure 16

LTC resident

Under age 65

fp health

cm impair

3+ Chronic Conditions

2%

11%

22%

25%

63%

17%

39%

48%

56%

70%

Dual-eligible Medicare bene-ficiaries

All other Medi-care 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

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 = $17,745Median Spending, 2010 = $7,464

Figure 18

<65

65+

<$20,000

$20,000-$39,999

>$40,000

Exc./V. Good/Good

Fair/Poor

0.0588677833438453

0.17

0.04

0.0995218195715378

0.0492615698857905

0.0331180396502578

0.03

0.13

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, 2012During the past year, percent of beneficiaries reporting that they…

Overall

Age

Income

Health Status

0.110142053262073

0.28

0.08

0.179229082285037

0.112158127408851

0.0450615148688645

0.07

0.22

…delayed getting health care due to cost…had trouble getting needed care

Figure 19

Medicare

Private non-capitated

Private capitated

Medicaid

Uninsured

91%

91%

72%*

71%*

47%*

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

Figure 20

NOTE: Pediatricians are 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)

Figure 21

NOTE: Medicare Shared 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, 2015Pioneer ACO participantsMedicare Shared Savings Program participants

Figure 22

NOTES: National readmission 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

July 2005-June 2008

July 2006-June 2009

July 2007-June 2010

July 2008-June 2011

July 2009-June 2012

July 2010-June 2013

15

16

17

18

19

20

21

22

23

24

25

26

24.5 24.7 24.8 24.7

23.0 22.7

19.9 19.9 19.8 19.7

18.317.8

18.2 18.3 18.4 18.517.6 17.3

Heart FailureHeart AttackPneumonia

Performance (measurement) Time Period

Nati

onal

Ave

rage

Rea

dmiss

ion

Rate

(%)

Diagnosis of initial hospitalization

Figure 23

Other212%

Nondefense Discre-tionary

17%

Defense17%

Social Security24%

Medicare114%

Medicaid, Exchange subsidies,

CHIP9%Net

Interest7%

Chart Title

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 TrillionNet Federal Medicare Outlays, 2014 = $505 Billion

Figure 24

Medicare Advantage

26%

Hospital Inpatient Services

23%

Physician Payments12%

Outpatient Prescription Drugs11%

Hospital Outpatient

Services7%

Skilled Nursing Facilities

5%

Home Health

3%Other

Services*14%

NOTE: *Other services 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

Figure 25

90%

42%

10%

58%

NOTE: Excludes Medicare 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

Figure 26

Total Services

Home Health Care

Prescription Drugs

Hospital Services

Physician Services

Nursing Home Care

Dental Services

22%

43%

28% 26%22% 22%

<1%

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 BillionsMedicare $551 $34 $75 $243 $130 $35 $0.5

Total $2,469 $80 $271 $937 $587 $156 $111

Figure 27

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

$446 $480 $466 $492 $505 $527 $560 $562 $574$642

$688$738

$833 $852 $866

$981

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

Figure 28

5.5%6.1%

2.9%2.4%

3.7%

4.7%

3.5%

2.2%

NOTE: *Assumes 0.6-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 insuranceper capita spending

GDP per capita

CPI

Figure 29

$575.8 billion $251.1 billion $255.0 billion $69.7 billionTOTAL Part A Part B Part D

3% 5% 2%2%6%0.01524172091116

870.1259634568184

75

13% 1% 25%14%

38%

88%

0.411215586292177

0.72877772896991

0.731409051111653

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

Figure 30

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

2020

20182019 2019

2017

2029

2024 2024

2026

2030

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

Figure 31

2000 2010 2020 2030 2040 20500

10

20

30

40

50

60

70

80

90

100

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

39.747.7

64.4

81.889.2 92.8

4.0

3.4

2.8

2.3 2.2 2.3

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