QUICK REFERENCE MEDICARE FACTS & STATISTICS
"...Medicare has been a boon to the elderly and their children. Surveys show that beneficiaries are overwhelmingly satisfied with their care. Before Medicare, only 56 percent of the elderly had hospital insurance; the program has contributed to an increase in life expectancy and a sharp reduction in poverty among the elderly."
Robert Pear, Walt Bogdanich, Some Successful Models Ignored as Congress Works on Drug Bill, NY Times, p.1 (9/4/2003)
How many elders and people with disabilities have Medicare as their health insurance?
How do the costs of Medicare compare with private insurance?
How does enrollment and costs in the traditional program compare with Medicare managed care?
For further information, follow one of the links below or scroll down the page.
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MEDICARE PART C (MANAGED CARE) |
APPEALS (under construction) |
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Category |
Statistics |
Source and Notes |
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44.8 million projected for 2008 43.1 million - 2006 ACTUAL |
CMS Data Compendium 2007, Populations, "Medicare Enrollees for Selected Years." |
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# of elders (65 & older) w/ Medicare |
37.6 projected for 2008 36.1 million - 2006 ACTUAL |
CMS Data Compendium 2007, Populations, "Medicare Enrollees for Selected Years." |
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# of people w/ Medicare who are younger than 65 & disabled |
7.1 projected for 2008 6.9 million - 2006 ACTUAL |
CMS Data Compendium 2007, Populations, "Medicare Enrollees for Selected Years." |
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% of people w/ Medicare who are younger than 65 & disabled |
15.8% projected for 2008 14.6% - 2004 ACTUAL |
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% of elders (65 & older) w/ health insurance before Medicare existed |
50% |
Kaiser, 4/2003. |
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% of elders (65 & older) w/ health insurance now |
95% are covered by Medicare (2005) 87% of non-institutionalized seniors also have supplemental insurance (2004) |
Administration on Aging, A Profile of Older Americans: 2006. |
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Medicare beneficiary median family income |
$20,400 (2002) |
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Income less than 100% of the federal poverty level |
16% (2005-2006) |
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Income < 400% FPL (~$38,000) |
77% (2004) |
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Income > $80,000 |
4% (2002) |
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1.7% of expenditures (2006) |
CMS Data Compendium 2007, "Medicare Administrative Expenses Selected Fiscal Years." |
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Medicare Advantage (private plans) average non-medical costs |
13.1% broken
down by: |
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1985 (from 1.35% to 1.45%)
Since 1994, no cap on maximum taxable earnings for Medicare |
Marilyn Moon, Urban Institute.
CMS Data Compendium 2007, "Medicare Annual Maximum Taxable Earnings, 1966-2007." |
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Spending increase per beneficiary |
6.6% (2002-2005) |
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Spending increase per beneficiary |
8.0% (2002-2005) |
Medicare Part C
(Medicare Advantage, Medicare Managed Care:
Private Plans)
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Category |
Statistics |
Source and Notes |
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# of Medicare Advantage (MA) contracts |
523 (2008) |
Kaiser Family Foundation, Medicare Advantage Contracts: 2008. |
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# of beneficiaries in MA plans |
8.9 million (2008) Increased from 4.6 million in 2003 |
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% of people in Medicare who are enrolled in MA plans |
20% (2007) Increased from 11% in 2004 |
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# of enrollees in plans offering Prescription Drugs |
7.63 million (2008) |
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Access to MA |
100% of beneficiaries have access to MA plans |
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Medicare Advantage Plan Enrollment, by Plan Type CCP = Coordinated Care Plans HMO = Health Maintenance Organization PPO = Preferred Provider Organization PFFS = Private Fee For Service MSA = Medical Savings Account |
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Kaiser Family Foundation, Medicare Advantage Plan Enrollment, by Plan Type. |
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Medicare Advantage Plan Penetration, by Plan Type (2007) |
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Kaiser Family Foundation, Medicare Advantage Plan Penetration, by Plan Type. |
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Medicare Advantage Contracts, by Plan Type (2008) |
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Kaiser Family Foundation, Medicare Advantage Contracts, by Plan Type. |
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Special Needs Plans (SNP) Enrollment, by SNP Type (2007) |
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CMS, Medicare Advantage Part D Enrollment Data, Special Needs Plan Data. |
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SNP Contracts by SNP Type (2008) |
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CMS, Medicare Advantage Part D Enrollment Data, Special Needs Plan Data. |
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Cost of MA program in 2006 |
$59 billion |
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Excess MA payments over 10 years |
Projected excess payments of $149 billion (2009-2017) |
CBO, Medicare Advantage: Private Health Plans in Medicare, June 28, 2007. |
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Average amount above a plan’s bid that CMS gives to MA plans |
$87 per member per month (2007) $8.3 billion paid out in total (2007) |
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$783 per beneficiary per month (projected 2007) |
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Average traditional Medicare payment per beneficiary |
$699 per beneficiary per month (2007) |
Extrapolated from other data. |
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MA payment as a percent of traditional Medicare costs |
113% (2008) |
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Program payments that exceed traditional Medicare expenditures, by plan type (2006) |
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Excess MA payments |
$10 billion |
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Category |
Statistics |
Source and Notes |
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# of beneficiaries in Part D Plans |
25.4 million (2008) |
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# of beneficiaries in stand-alone Prescription Drug Plans (PDP) |
17.39 million (2008) |
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# of beneficiaries in MA-PDs and other Medicare health plans with drug coverage |
8.01 million (2008) |
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# of beneficiaries with non-Medicare drug coverage (Government and private retirees) |
14.19 million (2008) |
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Average # Part D plans per state (2008) |
54 plans per state Low: 47 (Alaska) High: 63 (Pennsylvania) |
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Average premium for PDP for 2008 |
$39.86 (2008) $36.66 (2007) |
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% of PDPs with coverage in donut hole |
29% (2008) |
Avalere, Beneficiaries and the 2008 Medicare Part D Marketplace, slide 21. |
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# of PDPs with brand name coverage in donut hole |
1 plan (2008) |
Avalere, Beneficiaries and the 2008 Medicare Part D Marketplace, slide 21. |
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# of plans that are Low-Income Subsidy eligible |
495 (2008) 483 (2007) 411 (2006) |
Kaiser Family Foundation, Prescription Drug Plans that are Low-Income Subsidy Eligible. |
Low-Income Medicare Beneficiaries
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Category |
Statistics |
Source and Notes |
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# beneficiaries with incomes at 100% of the Federal Poverty Level |
7.7 million (18%) (2004) |
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# beneficiaries with incomes 100%-125% of the Federal Poverty Level |
4.3 million (10%) (2004) |
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# beneficiaries with incomes 125%-200% of the Federal Poverty Level |
9 million (21%) (2004) |
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# of beneficiaries estimated eligible for LIS |
12.5 million (2008) 13.2 million (2007) |
CMS, Prescription Drug Coverage Enrollment Information, LIS Eligible Beneficiaries. |
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# of beneficiaries enrolled in LIS |
9.4 million (2008) |
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| % of beneficiaries enrolled in LIS who are deemed through another program |
84% (2008) |
CMS, Prescription Drug Coverage, 2008 Enrollment Information. |
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% of estimated eligible beneficiaries enrolled in QMB |
33% |
CBO, A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit. |
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% of estimated eligible beneficiaries enrolled in SLMB |
13% |
CBO, A Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit. |
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# of dual eligibles |
7.5 million (2006) |
Kaiser Family Foundation, Dual Eligibles: Medicaid's Role for Low-Income Medicare Beneficiaries. |
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# LIS enrollees whose plan lost benchmark status |
2.56 million (2008) |
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# LIS enrollees reassigned to a new plan with the same sponsor |
965,482 (2008) |
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# LIS enrollees reassigned to a new plan with a different sponsor |
1.15 million (2008) |
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# LIS enrollees who must choose a new plan |
442,719 |
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Category |
Statistics |
Source and Notes |
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Rates of full and partial reversal of denials |
Under Construction |
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Category |
Statistics |
Source and Notes |
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# of people w/ Medicare |
540,170 (2008) |
Kaiser Family Foundation, (KFF) Total Medicare Beneficiaries. |
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# of people w/ Medicare Advantage |
54,825 (2007) |
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# of uninsured |
353,092 (2006) |
Kaiser Family Foundation, Health Insurance Coverage of the Total Population. |
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% of uninsured who are from working families |
33% (2006) |
Kaiser Family Foundation, Uninsured Rates for the Non-Elderly by Family Work Status. |
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% increase in workers premiums, 2000-2004 |
58.8% |
CT Health Care for All, 2004. |
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% increase in workers salaries, 2000-2004 |
14.4% |
CT Health Care for All, 2004 |
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% decrease in residents with employer provided health insurance |
5% (2005-2006) |
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% of people w/ Medicare who are 65 and older |
87.3% (2004) US 84.6% |
Kaiser Family Foundation, Distribution of Medicare Beneficiaries by Eligibility Category. |
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% of people w/ Medicare who are disabled |
12.7% (2004) US 15.3% |
Kaiser Family Foundation, Distribution of Medicare Beneficiaries by Eligibility Category. |
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# of people Medicare enrollees who are at or below 100% of the Federal Poverty Level |
14% (2005-2006) US 16% |
Kaiser Family Foundation, Distribution of Medicare Enrollees by Federal Poverty Level. |
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Category |
Statistics |
Source and Notes |
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# of overall US populace w/ chronic conditions |
133 million (2005) |
Partnership for Solutions, Chronic Conditions: Making the Case for Ongoing Care. |
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% of non-institutionalized Medicare beneficiaries with at least one chronic condition |
87% (2002) |
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% of Medicare spending on people with chronic conditions |
1 CC = 3% 99% of Medicare expenditures are for beneficiaries with 1 or more chronic conditions |
Partnership for Solutions, Chronic Conditions: Making the Case for Ongoing Care, page 27. |
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Average length of hospital stay for Medicare beneficiaries for short-stay hospitals |
5.6 days (2006) 6.0 days (2000) |
CMS Data Compendium, Utilization, "Medicare Short-Stay Hospital Utilization." |
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Average length of skilled nursing facility stay for Medicare beneficiaries per discharge |
34 days (2006) 31 days (2000) |
CMS Data Compendium, State Data, "Medicare Skilled Nursing Facility Utilization by State." |
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Average reimbursement per skilled nursing facility discharge |
$10,304 (2006) |
CMS Data Compendium 2006, State Data, "Medicare Skilled Nursing Facility Utilization by State." |
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Average # of home health visits per episode |
20 (2003) |
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Mean out-of-pocket spending, by income quintile for the elderly population, as a share of income |
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1970 |
1987 |
2002 |
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1 |
10% |
15% |
19% |
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2 |
9% |
12% |
13% |
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3 |
7% |
9% |
7% |
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4 |
5% |
6% |
5% |
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5 |
2% |
3% |
2% |
Copyright © 2010 Center for Medicare Advocacy, Inc.